Barriers along the care cascade of HIV-infected men in a large urban center of Brazil.
Global and national HIV/AIDS policies utilize the care cascade to emphasize the importance of continued engagement in HIV services from diagnosis to viral suppression. Several studies have documented barriers that men experience in accessing services at specific stages of care, but few have analyzed how these barriers operate along the care cascade. Brazil offers a unique setting for analyzing barriers to HIV care because it is a middle-income country with a large HIV epidemic and free, universal access to HIV/AIDS services. Semi-structured interviews were conducted in 2011 with HIV-infected men (n = 25) receiving care at the only HIV/AIDS state reference center in Salvador, Brazil, the third largest city in the country. Interviews were transcribed and coded for analysis. Researchers identified barriers to services along the care cascade: health service-related obstacles (poor-quality care, lengthy wait times, and drug supply problems); psychosocial and emotional challenges (fear of disclosure and difficulty accepting HIV diagnosis); indirect costs (transportation and absenteeism at work or school); low perceived risk of HIV; and toxicity and complexity of antiretroviral drug (ARV) regimens. The stages of the care cascade interrupted by each barrier were also identified. Most barriers affected multiple, and often all, stages of care, while toxicity and complexity of ARV regimens was only present at a single care stage. Efforts to eliminate more prevalent barriers have the potential to improve care continuity at multiple stages. Going forward, assessing the relative impact of barriers along one's entire care trajectory can help tailor improvements in service provision, facilitate achievement of viral suppression, and improve access to life-saving testing, treatment, and care.
a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA.
Michael
M
Hoffmann
b RAND Corporation , 1776 Main Street, Santa Monica , CA 90407 , USA.
Sarah
S
MacCarthy
a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA.
Ashley
A
Batson
c Icahn School of Medicine at Mount Sinai , 1428 Madison Ave, New York , NY 10029 , USA.
Ann
A
Crawford-Roberts
d Department of Family and Social Medicine , Montefiore Medical Center , 111 East 210th Street, Bronx , NY 10467 , USA.
Jennifer
J
Rasanathan
a Brown University School of Public Health and the Miriam Hospital , 121 South Main St. Suite 810, Providence , RI 02912 , USA.
Amy
A
Nunn
e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil.
Luis Augusto
LA
Silva
e Institute of Collective Health, Federal University of Bahia , Rua Basilio da Gama, s/n - Campus Universitario Canela, Salvador , Bahia , Brazil.
Ines
I
Dourado
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001938:Brazil; D003266:Continuity of Patient Care; D003695:Delivery of Health Care / Q000592:standards; D030881:Disclosure; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011287:Prejudice; D011369:Professional-Patient Relations; D036301:Qualitative Research; D011787:Quality of Health Care; D012944:Social Support; D014505:Urban Population / Q000706:statistics & numerical data
D044966:Anti-Retroviral Agents
Brazil; HIV/AIDS; barriers; care cascade; delay; men