title: Identifying Perceived Barriers along the HIV Care Continuum: Findings from Providers, Peer Educators, and Observations of Provider-Patient Interactions in Ethiopia.
abstract: Increasing the proportion of HIV-positive individuals who link promptly to and are retained in care remains challenging in sub-Saharan Africa, but little evidence is available from the provider perspective. In 4 Ethiopian health facilities, we (1) interviewed providers and peer educators about their perceptions of service delivery- and patient-level barriers and (2) observed provider-patient interactions to characterize content and interpersonal aspects of counseling. In interviews, providers and peer educators demonstrated empathy and identified nonacceptance of HIV status, anticipated stigma from unintended disclosure, and fear of antiretroviral therapy as patient barriers, and brusque counseling and insufficient counseling at provider-initiated testing sites as service delivery-related. However, observations from the same clinics showed that providers often failed to elicit patients' barriers to retention, making it unlikely these would be addressed during counseling. Training is needed to improve interpersonal aspects of counseling and ensure providers elicit and address barriers to HIV care experienced by patients.
authors.affiliation: Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA sk1346@hunter.cuny.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kulkarni
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Susie
authors.initials: S
authors.lastname: Hoffman
authors.affiliation: International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, New York, NY, USA.
authors.forename: Tsigereda
authors.initials: T
authors.lastname: Gadisa
authors.affiliation: International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, New York, NY, USA.
authors.forename: Zenebe
authors.initials: Z
authors.lastname: Melaku
authors.affiliation: School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Mesganaw
authors.initials: M
authors.lastname: Fantehun
authors.affiliation: International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, New York, NY, USA.
authors.forename: Muluneh
authors.initials: M
authors.lastname: Yigzaw
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA International Center for AIDS Care and Treatment Programs, Columbia University, Mailman School of Public Health, New York, NY, USA.
authors.forename: Wafaa
authors.initials: W
authors.lastname: El-Sadr
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Remien
authors.affiliation: Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Tymejczyk
authors.affiliation: Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, New York, NY, USA Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Nash
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Batya
authors.initials: B
authors.lastname: Elul
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care; D003376:Counseling; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D036301:Qualitative Research
keywords: Ethiopia; HIV/AIDS; barriers to care; observation of provider–patient interactions; provider perspectives; qualitative methods