"If you are here at the clinic, you do not know how many people need help in the community": Perspectives of home-based HIV services from health care workers in rural KwaZulu-Natal, South Africa in the era of universal test-and-treat

PLoS One. 2018 Nov 9;13(11):e0202473. doi: 10.1371/journal.pone.0202473. eCollection 2018.

Abstract

Background: Limited engagement in clinic-based care is affecting the HIV response. We explored the field experiences and perceptions of local health care workers regarding home-based strategies as opportunities to improve the cascade of care of people living with HIV in rural South Africa as part of a Universal Test-and-Treat approach.

Methods: In Hlabisa sub-district, home-based HIV services, including rapid HIV testing and counselling, and support for linkage to and retention in clinic-based HIV care, were implemented by health care workers within the ANRS 12249 Treatment-as-Prevention (TasP) trial. From April to July 2016, we conducted a mixed-methods study among health care workers from the TasP trial and from local government clinics, using self-administrated questionnaires (n = 90 in the TasP trial, n = 56 in government clinics), semi-structured interviews (n = 13 in the TasP trial, n = 5 in government clinics) and three focus group discussions (n = 6-10 health care workers of the TasP trial per group). Descriptive statistics were used for quantitative data and qualitative data were analysed thematically.

Results: More than 90% of health care workers assessed home-based testing and support for linkage to care as feasible and acceptable by the population they serve. Many health care workers underlined how home visits could facilitate reaching people who had slipped through the cracks of the clinic-based health care system and encourage them to successfully access care. Health care workers however expressed concerns about the ability of home-based services to answer the HIV care needs of all community members, including people working outside their home during the day or those who fear HIV-related stigmatization. Overall, health care workers encouraged policy-makers to more formally integrate home-based services in the local health system. They promoted reshaping the disease-specific and care-oriented services towards more comprehensive goals.

Conclusion: Because home-based services allow identification of people early during their infection and encourage them to take actions leading to viral suppression, HCWs assessed them as valuable components within the panel of UTT interventions, aiming to reach the 90-90-90 UNAIDS targets, especially in the rural Southern African region.

Trial registration: The registration number of the ANRS 12249 TasP trial on ClinicalTrials.gov is NCT01509508.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Delivery of Health Care* / methods
  • Delivery of Health Care* / organization & administration
  • Delivery of Health Care* / standards
  • Delivery of Health Care* / trends
  • Female
  • HIV Infections* / epidemiology
  • HIV-1*
  • Home Care Services* / organization & administration
  • Home Care Services* / standards
  • Home Care Services* / trends
  • Humans
  • Male
  • Rural Health Services* / organization & administration
  • Rural Health Services* / standards
  • Rural Health Services* / trends
  • South Africa / epidemiology
  • Surveys and Questionnaires*

Associated data

  • ClinicalTrials.gov/NCT01509508

Grants and funding

The ANRS TasP trial was sponsored by the French National Institute of Health and Medical Research‐French National Agency for AIDS and Viral Hepatitis Research (Inserm-ANRS), and was funded by the ANRS, the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, the International Initiative for Impact Evaluation (3iE), Gilead Sciences, Inc. and MERCK & Co., Inc. The two main researchers of this publication receive their salaries from the French charity Sidaction (MP) and the French school of Public Health (EHESP) (DP). The Department of Health of KwaZulu-Natal and of South Africa and the AHRI provided support. The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the trial partners. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.