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AIDS Behav. 2018 Mar;22(3):765-773. doi: 10.1007/s10461-017-1877-4.

Stumbling Blocks at the Clinic: Experiences of Seeking HIV Treatment and Care in South Africa.

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Southern Africa Labour and Development Research Unit, University of Cape Town, Rondebosch, Cape Town, 7701, South Africa.
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
Department of Health Services, Policy & Practice (HSPP), Brown University School of Public Health, Providence, RI, USA.
The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Department of Behavioral and Social Sciences, Brown University School of Public Health Providence, Providence, RI, USA.


Prompt antiretroviral therapy (ART) initiation maximises the therapeutic and prevention benefits of a treat-all strategy for HIV therapy. Using in-depth semi-structured interviews with men and women 18 years and older (N = 41), who were highly motivated and seeking treatment, this study examined salient factors that were associated with delays in treatment access and initiation. Results revealed clinic-related barriers including an onerous, inefficient multi-step process to initiate ART. Participants experienced additional delays due to difficulties accessing care (e.g., being turned away from clinics and referred elsewhere) and health service challenges. Health service challenges included difficulty securing appointments, administrative mistakes (especially lost clinic folders and test results), difficulty navigating the clinic system (e.g., failure to collect a queue card or waiting for incorrect services) and negative clinic-patient interactions. Overall, there was a pervasive negative perception of clinics. Results strongly indicate the need for more patient-centred models of care and the need to reduce unnecessary patient-days at clinics.


Antiretroviral therapy initiation; Barriers to treat-all; HIV care continuum; HIV treatment access; Linkage to care

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