Negative clinic experiences as a barrier to care for people with HIV and their impact on patient preferences for intervention support: a qualitative study in Cape Town, South Africa

ABSTRACT

We conducted qualitative research among people with HIV (PWH) and care providers in Cape Town, South Africa to understand the impact of negative clinic experiences on adherence and support preferences. In-depth interviews were conducted with 41 patients with an unsuppressed viral load or a treatment gap, and focus group discussions with physicians, nurses, counselors, and community health workers. Questions addressed treatment history and adherence barriers, then participants evaluated evidence-based adherence interventions for potential scale up. Inductive analysis examined care experiences and corresponding preference for intervention options. More than half of PWH described negative experiences during clinic visits, including mistreatment by staff and clinic administration issues, and these statements were corroborated by providers. Those with negative experiences in care stated that fear of mistreatment led to nonadherence. Most patients with negative experiences preferred peer support groups or check-in texts to clinic-based interventions. We found that PWH’s negative clinic experiences were a primary reason behind nonadherence and influenced preferences for support mechanisms. These findings emphasize the importance of HIV treatment adherence interventions at multiple levels both in and outside of the clinic, and providing more comprehensive training to providers to better serve PWH in adherence counseling, especially those who are most vulnerable..

KEYWORDS:

• HIV/AIDS
• South Africa
• qualitative
• ART adherence

SUSTAINABLE DEVELOPMENT GOALS:

• SDG 3: Good health and well-being

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board at Boston University Medical Campus (approval no. H-38872), the research ethics committee of the University of Cape Town, and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent to participate

Written informed consent was obtained from all participants in this study.

Consent for publication

All consent forms included the language: “Information from this study may be used for research purposes and may be published, but your name will not be used.”

Ethics statement

Our study was approved by the institutional review boards at Boston University Medical Campus and the research ethics committee at the University of Cape Town (approval no. H-38872). All participants provided written informed consent prior to enrollment in the study.

Additional information

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Established Investigator Innovation Award at the Boston University School of Public Health.