«Ashamed of being seen in an HIV clinic»: a qualitative analysis of barriers to engaging in HIV care from the perspectives of patients and healthcare workers in the Daraja clinical trial

Barriers to Engaging in HIV Care: Insights from the Daraja Clinical Trial

Background

Many people with HIV face high risks after leaving the hospital. Their survival rates improve significantly when they start attending HIV clinics early and stick to their treatment plans. The Daraja intervention, a tailored management strategy tested in Tanzania, showed positive results in helping patients link to clinics, stay engaged, and adhere to their treatment.

Methodology

We interviewed 40 participants (20 from a control group and 20 from the intervention group) one year after joining the trial. We wanted to understand the challenges they faced in accessing HIV care. We also spoke with 20 healthcare providers to gather more insights. Our analysis focused on key themes related to barriers in care engagement.

Results

Key barriers identified included:

  • Stigma: Many patients felt ashamed of visiting HIV clinics, which affected their decision-making about where to seek care.
  • Mistrust: Patients often mistrusted healthcare providers.
  • Financial Issues: Underemployment and unstable income made it hard for patients to attend clinics.
  • Transport Problems: Unreliable transport options hindered access to care.
  • Lack of Support: Many patients lacked social support to encourage them in their treatment journey.

The Daraja intervention helped reduce stigma, improve social support, boost patients’ confidence, and better equip them to navigate HIV clinics.

Conclusion

This research highlights critical barriers to HIV care and shows how the Daraja intervention helped improve patients’ experiences by addressing stigma, enhancing support, and increasing their ability to access care.

Trial Registration

The Daraja trial is registered at ClinicalTrials.gov, NCT03858998.

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