@article{fdi:010080450,
  title = {{T}est but not treat : community members' experiences with barriers and facilitators to universal antiretroviral therapy uptake in rural {K}wa{Z}ulu-{N}atal, {S}outh {A}frica},
  author = {{I}wuji, {C}. and {C}himukuche, {R}. {S}. and {Z}uma, {T}. and {P}lazy, {M}. and {L}armarange, {J}oseph and {O}rne-{G}liemann, {J}. and {S}iedner, {M}. and {S}hahmanesh, {M}. and {S}eeley, {J}.},
  editor = {},
  language = {{ENG}},
  abstract = {{I}ntroduction {A}ntiretroviral therapy ({ART}) has revolutionised the care of {HIV}-positive individuals resulting in marked decreases in morbidity and mortality, and markedly reduced transmission to sexual partners. {H}owever, these benefits can only be realised if individuals are aware of their {HIV}-positive status, initiated and retained on suppressive lifelong {ART}. {F}ramed using the socio-ecological model, the present study explores factors contributing to poor {ART} uptake among community members despite high acceptance of {HIV}-testing within a {T}reatment as {P}revention ({T}as{P}) trial. {I}n this paper we identify barriers and facilitators to treatment across different levels of the socio-ecological framework covering individual, community and health system components. {M}ethods {T}his research was embedded within a cluster-randomised trial ({C}linical{T}rials.gov, number {NCT}01509508) of {HIV} treatment as {P}revention in rural {K}wa{Z}ulu-{N}atal, {S}outh {A}frica. {D}ata were collected between {J}anuary 2013 and {J}uly 2014 from resident community members. {T}en participants contributed to repeat in-depth interviews whilst 42 participants took part in repeat focus group discussions. {D}ata from individual interviews and focus group discussions were triangulated using community walks to give insights into community members' perception of the barriers and facilitators of {ART} uptake. {W}e used thematic analysis guided by a socio-ecological framework to analyse participants' narratives from both individual interviews and focus group discussions. {R}esults {B}arriers and facilitators operating at the individual, community and health system levels influence {ART} uptake. {S}tigma was an over-arching barrier, across all three levels and expressed variably as fear of {HIV} disclosure, concerns about segregated {HIV} clinical services and negative community religious perceptions. {O}ther barriers were individual (substance misuse, fear of {ART} side effects), community (alternative health beliefs). {F}acilitators cited by participants included individual (expectations of improved health and longer life expectancy following {ART}, single tablet regimens), community (availability of {ART} in the community through mobile trial facilities) and health system factors (fast and efficient service provided by friendly staff). {D}iscussion {W}e identified multiple barriers to achieving universal {ART} uptake. {T}o enhance uptake in {HIV} care services, and achieve the full benefits of {ART} requires interventions that tackle persistent {HIV} stigma, and offer people with {HIV} respectful, convenient and efficient services. {T}hese interventions require evaluation in appropriately designed studies.},
  keywords = {{AFRIQUE} {DU} {SUD} ; {KWAZULU} {NATAL}},
  booktitle = {},
  journal = {{PL}o{S} {O}ne},
  volume = {15},
  numero = {9},
  pages = {e0239513 [14 p.]},
  ISSN = {1932-6203},
  year = {2020},
  DOI = {10.1371/journal.pone.0239513},
  URL = {https://www.documentation.ird.fr/hor/fdi:010080450},
}