title: Policy and practice, lost in transition: Reasons for high drop-out from pre-antiretroviral care in a resource-poor setting of eastern Uganda.
abstract: OBJECTIVE
  This study explores reasons for drop-out from pre-ARV care in a resource-poor setting where premature death is a common consequence of delayed ARV initiation.
  
  
  METHODS
  In Iganga, Uganda, we conducted key informant interviews with staff at the pre-ARV clinic, focus group discussions with persons who looked after people living with HIV (PLWH) and in-depth interviews with PLWH half of whom had dropped out of pre-ARV care. Content data analysis was done to identify recurrent themes.
  
  
  RESULTS
  Reasons cited for dropping out of pre-ARV care include: inadequate post-test counseling due to staff work overload, competition from the holistic and less stigmatizing traditional/spiritual healers. Others were transportation costs, long waiting time lack of incentives to seek pre-ARV care by healthy looking PLWH and gender inequalities.
  
  
  CONCLUSIONS
  Pre-ARV adherence counseling should be improved through recruitment of counselors or multi-skilling in counseling skills for the available staff to reduce on the work load. Traditional/ spiritual healers should be integrated and supervised to offer pre-ARV care. Door step supply of cotrimoxazole using agents could reduce transport costs, waiting time and increase access to pre-ARV. Women should be sensitized on comprehensive HIV care through the local media and local leaders to address gender inequalities.
authors.affiliation: District Health Office, Iganga District Administration, PO Box 358, Iganga, Uganda. dlmuhamadi@yahoo.co.uk
authors.forename: Muhamadi
authors.initials: M
authors.lastname: Lubega
authors.forename: Xavier
authors.initials: X
authors.lastname: Nsabagasani
authors.forename: Nazarius M
authors.initials: NM
authors.lastname: Tumwesigye
authors.forename: Fred
authors.initials: F
authors.lastname: Wabwire-Mangen
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekström
authors.forename: George
authors.initials: G
authors.lastname: Pariyo
authors.forename: Stefan
authors.initials: S
authors.lastname: Peterson
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003376:Counseling; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D006295:Health Resources; D006801:Humans; D055048:Integrative Medicine; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D016488:Medicine, African Traditional; D008875:Middle Aged; D009042:Motivation; D010352:Patient Dropouts / Q000193:education / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D013240:Stereotyping; D011795:Surveys and Questionnaires; D014186:Transportation; D014454:Uganda / Q000453:epidemiology; D014933:Women's Rights; D016526:Workload; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents