Information, motivation, and behavioral skills for early pre-ART engagement in HIV care among patients entering clinical care in KwaZulu-Natal, South Africa

Abstract

Little is known regarding factors implicated in early engagement and retention in HIV care among individuals not yet eligible for antiretroviral therapy (pre-ART) in sub-Saharan Africa. Identifying such factors is critical for supporting retention in pre-ART clinical care to ensure timely ART initiation and optimize long-term health outcomes. We assessed patients' pre-ART HIV care-related information, motivation, and behavioral skills among newly diagnosed ART-ineligible patients, initiating care in KwaZulu-Natal, South Africa. The survey was interviewer-administered to eligible patients, who were aged 18 years or older, newly entering care (diagnosed within the last six-months), and ineligible for ART (CD4 count > 200 cells/mm³) in one of four primary care clinical sites. Self-reported information, motivation, and behavioral skills specific to retention in pre-ART HIV-care were characterized by categorizing responses into those reflecting potential strengths and those reflective of potential deficits. Information, motivation, and behavioral skills deficits sufficiently prevalent in the overall sample (i.e.,≥30% prevalent) were identified as areas in need of specific attention through intervention efforts adapted to the clinic level. Gender-based differences were also evaluated. A total of 288 patients (75% female) completed structured interviews. Across the sample, eight information, eight motivation, and eight behavioral skills deficit areas were identified as sufficiently prevalent to warrant specific targeted attention. Gender differences did not emerge. The deficits in pre-ART HIV care-related information, motivation, and behavioral skills that were identified suggest that efforts to improve accurate information on immune function and HIV disease are needed, as is accurate information regarding HIV treatment and transmission risk prior to ART initiation. Additional efforts to facilitate the development of social support, including positive interactions with clinic staff and decreasing community-level stigma and to decrease structural and resource-depleting demands of HIV care may be particularly valuable to facilitate retention in pre-ART HIV care.

Keywords:

• retention in HIV care
• early engagement in HIV care
• IMB
• pre-ART
• South Africa

Acknowledgments

The authors acknowledge the KwaZulu-Natal (KZN) Department of Health (DOH) and uMkhanyakude (DC 27) and uMgungundlovu (DC 22) health districts for their collaboration and support. In addition, they are greatly appreciative of the efforts of the onsite research assistants who collected these data, including Nomvula Mlambo, Nonsikelelo Gcumisa, Lindani Mngomezulu, Sithandiwe Mthethwa, Gerald Dlamini, and Hlengiwe Zikhali. A special thanks to Zandile Jojo for assistance with translations, to Colin Barr and Franky Ngomu for assistance with data preparation for analyses, and to Ntombenhle Ngcobo for her significant contributions to measure development. They are also thankful for the participants who provided their time and insights regarding their experiences in HIV care. This study was supported by supplement funding from President's Emergency Program for AIDS Relief (PEPFAR) and Office of AIDS Research (OAR) to grant number R01MH77524-05, Jeffrey D. Fisher, Ph.D., funded by the National Institute of Mental Health (NIMH). A NIMH training grant F31 MH093264, Laramie R. Smith, M.A., further funded efforts for the preparation of this manuscript. This research was supported by a supplement to NIMH grant R01MH77524-05.