Pathways to engagement in HIV care for newly-diagnosed South Africans

Despite the global effort to scale up treatment programs and increase access to antiretroviral therapy (ART) for HIV-positive people living in resource-constrained nations, many are entering care too late to benefit from ART. The overall goals of this four-year study, conducted in Durban, South Africa, are to determine the most salient influences on enrollment and retention in HIV care that, if addressed, could optimize use of services among newly diagnosed men and women in resource-constrained settings. Additionally, we aim to identify promising interventions for further development and testing.

Through an eight-month prospective cohort study following 463 newly diagnosed women and men recruited from primary health clinics, we seek to determine facilitators of and barriers to enrollment and retention in care at multiple levels: social structural (stigma, poverty, gender inequalities), health system (organization, policies, providers), and individual (mental health, social cognitions, health-related behaviors). In addition, we are exploring decision making around disclosure, enrollment, and retention in care through in-depth interviews with a sub-sample of cohort participants and have assessed HIV counselors at the recruitment sites to obtain a measure of counselor influence on client behavior. All recruitment and participant interview activities are complete, and the study is in the final phase of data entry, with preliminary analysis underway.