Human Immunodeficiency Virus (HIV) Clinical Trial
Official title:
Multi-level Determinants of Late ART Initiation in Sub-Saharan Africa (LSTART Study): A Cross-sectional Qualitative Situation Analysis at 4 HIV Care and Treatment Clinics in Ethiopia
The availability of HIV care and treatment programs is increasing in sub-Saharan Africa.
However more than half the patients who need HIV medicines are still not receiving this
antiretroviral therapy (ART), and this can lead to early death from AIDS. One of the
problems in this region is that patients start ART late, after the HIV disease is very
advanced. This results in high death rates soon after ART initiation. The way clinic-level
factors, such as the way services and referrals are organized, how referrals are regarded,
counseling messages and record-keeping, contribute to late ART initiation is unclear. As the
second phase of a 3-phase NIH-sponsored project, this study will identify clinic-level
enablers and barriers to timely enrollment into HIV care and ART initiation. A
cross-sectional qualitative study will be conducted at 4 selected HIV care and treatment
clinics and the health facilities in which they are located in Ethiopia. Data will be
collected using 4 methods:
1. Data abstraction
2. Key informant interviews with clinic personnel
3. Observation of post-test counseling sessions in the VCT clinic
4. Observation of provider-patient interactions in the care and treatment clinic
Identifying modifiable health facility-level predictors of late ART initiation will
facilitate implementation of interventions, programs and policies that will increase
the number of patients who enroll in HIV care and initiate ART early. Additionally,
results will inform the design of the third phase of the NIH-project referenced above.
Background: Although HIV care and treatment programs are scaling up in sub-Saharan Africa,
more than 50% of patients who need ART are not receiving it and significant mortality from
AIDS persists. One major challenge in this region is high rates of late ART initiation
(i.e., in the advanced stages of HIV disease) which results in high rates of mortality soon
after ART initiation. The clinic-level factors that contribute to late ART initiation are
unclear.
Objective: As the second of a 3-phase NIH-sponsored project, this study aims to identify
clinic-level enablers and barriers to timely ART initiation.
Methods: A cross-sectional qualitative study will be conducted at 4 purposively selected HIV
care and treatment clinics in Ethiopia. Data will be collected using 4 methods:
1. Data abstraction
2. Key informant interviews with clinic personnel
3. Observation of post-test counseling sessions at the voluntary counseling and testing
(VCT) clinic
4. Observation of provider-patient interactions in the care and treatment clinic
Descriptive statistics will be produced from the data abstraction. Content analysis of
key informant interviews will be conducted. Descriptive summaries will be produced from
observations. All analyses will focus on identifying within- and across-clinic themes,
and include triangulation across data collection methods to identify clinic-level
enablers and barriers to timely ART initiation.
Expected use of results: Identifying modifiable clinic-level enablers and barriers to timely
ART initiation will facilitate implementation of interventions, programs and policies to
reduce late ART initiation. Additionally, results will inform the third phase of the
NIH-project referenced above.
;
Time Perspective: Cross-Sectional
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