Pathways to HIV testing and care in Goa, India: exploring psychosocial barriers and facilitators using mixed methods

BMC Public Health

Research Article

Anisha Lazarus¹  Vikram Patel²  Savio Rodrigues³  Melanie Abas⁴  Martin Prince⁴  Rosie Mayston⁴  Ramesh Paranjape⁵  Priya Korgaonkar⁶ 

[1] Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK;Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, UK;Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, 403501, Bardez, Goa, India;Department of Microbiology, Goa Medical College and Hospital, Bambolim, Tiswadi, Goa, India;Health Service & Population Research Department, Kings College London, SE5 8AF, London, UK;National AIDS Research Institute, 73, ‘G’-Block, MIDC, 411 026, Bhosari, Pune, India;Sangath, H No 451 (168), Bhatkar Waddo, Socorro, Porvorim, 403501, Bardez, Goa, India;

关键词: Common Mental Disorder;    Hazardous Alcohol;    Item Patient Health Questionnaire;    Delay Recall Test;    Item Generalise Anxiety Disorder;   

DOI  :  10.1186/s12889-016-3456-4

 received in 2016-02-23, accepted in 2016-08-05,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundDespite recognition of the importance of timely presentation to HIV care, research on pathways to care is lacking. The adverse impact of depression upon adherence to antiretroviral therapy is established. There is emerging evidence to suggest depression may inhibit initial engagement with care. However, the effect of depression and other psychosocial factors upon the pathway to care is unknown.MethodsWe used mixed methods to explore pathways to care of people accessing testing and treatment in Goa, India. Questionnaires including measures of common mental disorder, hazardous alcohol use, cognition and assessment of pathways to care (motivations for testing, time since they were first aware of this reason for testing, whether they had been advised to test, who had given this advice, time elapsed since this advice was given) were administered to 1934 participants at the time of HIV testing. Qualitative interviews were carried out with 15 study participants who attended the antiretroviral therapy treatment centre. Interview topic guides were designed to elicit responses that discussed barriers and facilitators of accessing testing and care.ResultsPathways were often long and complex. Quantitative findings revealed that Common Mental Disorder was associated with delayed testing when advised by a Doctor (the most common pathway to testing) (AOR = 6.18, 2.16–17.70). Qualitative results showed that triggers for testing (symptoms believed to be due to HIV, and for women, illness or death of their husband) suggested that poor health, rather than awareness of risk was a key stimulus for testing. The period immediately before and after diagnosis was characterised by distress and fear. Stigma was a prominent backdrop to narratives. However, once participants had made contact with care and support (HIV services and non-governmental organisations), these systems were often effective in alleviating fear and promoting confidence in treatment and self-efficacy.ConclusionThe effectiveness of formal and informal systems of support around the time of diagnosis in supporting people with mental disorder is unclear. Ways of enhancing these systems should be explored, with the aim of achieving timely presentation at HIV care for all those diagnosed with the disease.

【 授权许可】

CC BY   
© The Author(s). 2016