A survey to explore factors that delay patients from accessing antiretroviral treatment at an East London hospital complex clinic
Thesis (MFamMed)--Stellenbosch University, 2012.
ENGLISH ABSTRACT: Introduction This cross-sectional study assessed factors affecting access to antiretroviral therapy (ART) among HIV patients. The aim of this study was to explore factors that delay patients from accessing antiretroviral treatment at an East London Hospital Complex clinic and to determine the pathway that people from communities in the surrounding area take in order to access antiretroviral treatment at the referral hospital ART clinic Methods The study design was a descriptive cross-sectional survey using both open and closed questions to generate qualitative and quantitative data. The survey used a questionnaire administered via a face to face interview. 200 Adult patients (>18years old) from the local population with a CD4 count of ≤100/mm3 referred to the ART clinic at East London Hospital Complex for the first time during May to October 2011 were interviewed. Results With the health system, some issues were structural (staffing, availability of CD4 counts) and most were process related and reflected a poor patient experience and lack of trust in the quality of care. Contextual related issues were mainly geographic accessibility (cost and lack of transport, distance to health care facility), stigma and discrimination about HIV. Patients related factors included misperceptions and false beliefs about HIV, low level of education, socioeconomic factors, lack of family and social support such as unavailability of treatment supporter and status of patient’s general health discouraged people from seeking ART. Coping strategies such as denial of results and reluctant to disclose results to other people came out as a distrust of patients in community. Conclusions This study gives evidence that people living with HIV experience health system, patient and contextual related barriers to access HIV treatment. The majority accessed care via their local primary care clinic and traditional or alternative practitioners did not appear to play a major role. The distance from and cost of transport to the referral hospital ART service was a major issue compounded by the difficulty of travelling when acutely sick. The expectation of long waiting times and sometimes negative staff attitudes reduced motivation. A number of other factors related to the patient, the health service and the community context were also identified. Many of these factors that reduce access to ART are amenable to change.