Naik, R., Zembe, W., Adigun, F., et al. AIDS and Behavior (June 2017), doi:10.1007/s10461-017-1830-6.
This qualitative study examined factors that influenced linkage to care among 30 HIV-positive clients who were tested in a home-based HIV counseling and testing (HBHCT) approach in South Africa. The authors categorized findings into individual, relationship, community, and health system levels. In-depth interviews revealed that at the individual level, a client’s ability to cope influenced the time between diagnosis and linkage to care. Clients who linked directly to care accepted their diagnosis, and had sought testing because they believed that something was wrong with their health. At the relationship level, clients who lacked close personal relationships were more likely to delay care. Those who linked quickly to care described receiving strong emotional and financial support from their relationships. At the community level, poor clients, those living in rural areas, and those who were busy taking care of others or searching for jobs were more likely to delay care. At the health system level, long waiting times, being turned away, poor staff attitudes, supply shortages, and a break in client confidentiality presented barriers to care, including for those who did not experience barriers on any other level. The authors stressed the need to assess factors that influence linkage to care during HBHCT, including social support, personal motivations, and available resources. They also endorsed integrating monitoring of linkage to care into HBHCT services.