Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Barriers and facilitators of retention in HIV care and treatment services in Iringa, Tanzania: The importance of socioeconomic and sociocultural factors

TitleBarriers and facilitators of retention in HIV care and treatment services in Iringa, Tanzania: The importance of socioeconomic and sociocultural factors
Publication TypeJournal Article
Year of Publication2014
AuthorsTomori, C, Kennedy, CE, Brahmbhatt, H, Wagman, JA, Mbwambo, JK, Likindikoki, S, Kerrigan, DL
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
ISBN Number09540121 (ISSN)
KeywordsAdult, Anti-HIV Agents, Antiretroviral therapy, antiretrovirus agent, article, Care and treatment, Community, cultural factor, Culture, Female, health care access, health care delivery, Health Knowledge, Attitudes, Practice, Health Services Accessibility, highly active antiretroviral therapy, HIV, HIV Infections, human, Human immunodeficiency virus infection, Humans, infection risk, Interviews as Topic, major clinical study, Male, Medicine, African Traditional, Middle Aged, Patient Acceptance of Health Care, patient compliance, Poverty, priority journal, Public Opinion, Retention, Sexual and Reproductive Health, social aspect, Social Stigma, Social Support, Sociocultural barriers, Socioeconomic barriers, Socioeconomic Factors, socioeconomics, stigma, tanzania

Although an increasing number of people living with HIV (PLHIV) in sub-Saharan Africa are benefiting from the rapid scale-up of antiretroviral therapy (ART), retention in HIV care and treatment services remains a major concern. We examined socioeconomic and sociocultural barriers and potential facilitators of retention in ART in Iringa, Tanzania, a region with the second highest prevalence of HIV in the country. In 2012, 116 in-depth interviews were conducted to assess community members' perceptions, barriers and facilitators of HIV treatment in Iringa, including key informants, persons at heightened risk for infection, and HIV service-delivery users. Data were transcribed, translated, entered into Atlas.ti, coded, and analyzed for key themes. In order to provide the full range of perspectives across the community on issues that may affect retention, we report findings from all 116 participants, but draw on verbatim quotes to highlight the experiences of the 14 PLHIV who reported that they were receiving HIV care and treatment services. Despite the growing availability of HIV care and treatment services in Iringa, participants reported significant barriers to retention, including lack of knowledge and misperceptions of treatment, access problems that included difficulties in reaching distant clinics and pervasive poverty that left PLHIV unable to cope with out-of-pocket costs associated with their care, persistent stigmatization of PLHIV and frequent reliance on alternative healing systems instead of biomedical treatment. Positive perceptions of the efficacy of ART, improved ART availability in the region, improved access to care through supplemental aid, and social support were perceived to enhance treatment continuation. Our findings suggest that numerous socioeconomic and sociocultural barriers inhibit retention in HIV care and treatment services in this setting. Intervention strategies that improve ART accessibility, incorporate supplemental aid, enhance social support, reduce stigma, and develop partnerships with alternative healers are needed to improve HIV-related outcomes. © 2013 Taylor & Francis.