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Table 5 Total identified and unresolved barriers to enrollment or retention in HIV care among CommLink clients, Manzini region, Eswatini, March 2016 – September 2018a

From: Antiretroviral therapy initiation and retention among clients who received peer-delivered linkage case management and standard linkage services, Eswatini, 2016–2020: retrospective comparative cohort study

 

All Clients

(n = 773)

All Barriers Resolvedb

(n = 316)

1–2 Barriers Unresolvedc

(n = 243)

 ≥ 3 Unresolved Barriersc

(n = 44)

Enrollment & Retention Barriers

Total

Barriers

Unresolved

Barriers

Total

Barriers

Unresolved

Barriers

Total

Barriers

Unresolved

Barriers

Total

Barriers

Unresolved

Barriers

Total (% of total barriers)

1372

476 (35)

637

–

551

308 (56)

184

168 (91)

 Median (IQR)

1 (1–3)

0 (0–1)

2 (1–3)

–

2 (1–3)

1 (1–2)

4 (3–5)

3 (3–4)

Type (% of clients)

 Non-disclosured

–

123 (16)

–

–

–

100 (41)

–

23 (52)

 Too busye

241 (31)

51 (7)

129 (41)

–

82 (33)

28 (12)

30 (68)

23 (52)

 Perceived wellnessf

95 (12)

24 (3)

43 (14)

–

31 (13)

4 (2)

21 (48)

20 (45)

 Concerned about stigmag

134 (17)

36 (5)

63 (20)

–

52 (21)

18 (7)

19 (43)

18 (41)

 Fears response from or loss of partnerh

101 (13)

30 (4)

49 (16)

–

39 (16)

18 (7)

13 (30)

12 (27)

 Excessive alcohol use

136 (18)

73 (9)

58 (18)

–

65 (27)

61 (25)

13 (30)

12 (27)

 Denies having HIVi

60 (8)

13 (2)

30 (9)

–

19 (8)

3 (1)

11 (25)

10 (23)

 Costs are too highj

81 (10)

23 (3)

47 (15)

–

25 (10)

14 (6)

9 (20)

9 (20)

 ART has side effects or is ineffectivek

81 (10)

14 (2)

52 (16)

–

19 (8)

5 (2)

10 (23)

9 (20)

 Believes in traditional medicine

18 (2)

8 (1)

6 (2)

–

6 (2)

2 (1)

6 (14)

6 (14)

 Believes prayer can prevent or cure AIDS

16 (2)

6 (1)

7 (2)

–

4 (2)

1 (0)

5 (11)

5 (11)

 HIV-care providers are disrespectful

44 (6)

5 (1)

28 (9)

–

11 (5)

1 (0)

5 (11)

4 (9)

 Quality of HIV care is poorl

40 (5)

4 (1)

27 (9)

–

9 (4)

0

4 (9)

4 (9)

 Other

202 (26)

66 (9)

98 (31)

–

89 (37)

53 (22)

15 (34)

13 (30)

  1. IQR interquartile range, ART antiretroviral therapy, AIDS acquired immunodeficiency syndrome
  2. aBarriers were routinely assessed and recorded on a standard form throughout the CommLink case management period (median 52 days, IQR 35—69)
  3. bJudged by peer counselors at the end of case management to no longer interfere with or prevent early enrollment or retention in HIV care
  4. cJudged by peer counselors at the end of case management to interfere with or prevent early enrollment or retention in HIV care
  5. dDid not disclose HIV status to any sexual partners or family members during case management
  6. eToo busy with work, family, or other responsibilities to enroll or remain in HIV care
  7. fDoes not believe enrolling in HIV care and ART is needed because of perceived good health and wellbeing
  8. gFears loss of confidentiality and stigma when visiting healthcare facilities
  9. hFears lack of support, violence, or separation from spouse or sexual partner
  10. iBelieves that the HIV test results were wrong and denies having HIV
  11. jBelieves transportation costs or costs from loss of work are too high
  12. kBelieves ART has severe side effects or is ineffective
  13. lBelieves that the quality of HIV care is poor and does not trust healthcare providers
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