Access to HIV care and treatment for migrants between Lesotho and South Africa: a mixed methods study

BMC Public Health

on behalf of EQUIP Innovation for Health Team¹  Alfred Musekiwa²  Thembisile Xulu²  Phetole Mahasha²  Pedro T. Pisa²  Iyiola Faturiyele³  Dimitris Karletsos³  Mantiti Khabo³  Marethabile Mariti³  Keletso Ntene-Sealiete⁴ 

[1] ;EQUIP – Innovation for Health;EQUIP-Innovation for Health;Ministry of Health;

关键词: HIV care and treatment;    Migrants;    ART;    Lesotho;    South Africa;    Multi month scripting and dispensing;   

DOI  :  10.1186/s12889-018-5594-3

来源: DOAJ

【 摘 要 】

Abstract Background HIV treatment and care for migrants is affected by their mobility and interaction with HIV treatment programs and health care systems in different countries. To assess healthcare needs, preferences and accessibility barriers of HIV-infected migrant populations in high HIV burden, borderland districts of Lesotho. Methods We selected 15 health facilities accessed by high patient volumes in three districts of Maseru, Leribe and Mafeteng. We used a mixed methods approach by administering a survey questionnaire to consenting HIV infected individuals on anti-retroviral therapy (ART) and utilizing a purposive sampling procedure to recruit health care providers for qualitative in-depth interviews across facilities. Results Out of 524 HIV-infected migrants enrolled in the study, 315 (60.1%) were from urban and 209 (39.9%) from rural sites. Of these, 344 (65.6%) were women, 375 (71.6%) were aged between 26 and 45 years and 240 (45.8%) were domestic workers. A total of 486 (92.7%) preferred to collect their medications primarily in Lesotho compared to South Africa. From 506 who responded to the question on preferred dispensing intervals, 63.1% (n = 319) preferred 5–6 month ARV refills, 30.2% (n = 153) chose 3–4 month refills and only 6.7% (n = 34) opted for the standard-of-care 1–2 month refills. A total of 126 (24.4%) defaulted on their treatment and the primary reason for defaulting was failure to get to Lesotho to collect medication (59.5%, 75/126). Treatment default rates were higher in urban than rural areas (28.3% versus 18.4%, p = 0.011). Service providers indicated a lack of transfer letters as the major drawback in facilitating care and treatment for migrants, followed by discrimination based on nationality or language. Service providers indicated that most patients preferred all treatment services to be rendered in Lesotho, as they perceive the treatment provided in South Africa to be different often less strong or with more serious side effects. Conclusion Existing healthcare systems in both South Africa and Lesotho experience challenges in providing proper care and treatment for HIV infected migrants. A need for a differentiated model of ART delivery to HIV infected migrants that allows for multi-month scripting and dispensing is warranted.

【 授权许可】

Unknown