title: Barriers to Linkage to HIV Care in Ugandan Fisherfolk Communities: A Qualitative Analysis.
abstract: Among Ugandan fisherfolk, HIV prevalence (with estimates ranging from 15 to 40 %) is higher than in the general population (about 7 %), potentially due to high-risk behaviors and low access to HIV testing and healthcare. We conducted semi-structured interviews on barriers to linkage to care with 10 key stakeholders and 25 fisherfolk within 1-2 months of their testing HIV-positive at clinic outreach events in Ugandan Lake Victoria communities. Interviews were recorded, transcribed, translated, and coded using grounded theory methods. Participants cited low healthcare access and quality of care, mobility, competing needs for work during clinic hours, stigma, and low social support as barriers. Over 10 % of clients screened positive for HIV at outreach events, and only half accessed care. Linkage to care issues may begin with the failure to attract high-risk fisherfolk to testing. New models of HIV testing and treatment delivery are needed to reach fisherfolk.
authors.affiliation: Health Unit, RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA. lbogart@rand.org.|Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA. lbogart@rand.org.|Department of Pediatrics, Harvard Medical School, Boston, MA, USA. lbogart@rand.org.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Bogart
authors.affiliation: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Rose
authors.initials: R
authors.lastname: Naigino
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Maistrellis
authors.affiliation: Health Unit, RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
authors.affiliation: Mildmay Uganda, Lweza, Uganda.
authors.forename: William
authors.initials: W
authors.lastname: Musoke
authors.affiliation: Mildmay Uganda, Lweza, Uganda.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mukasa
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Riana
authors.initials: R
authors.lastname: Jumamil
authors.affiliation: Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
authors.forename: Rhoda K
authors.initials: RK
authors.lastname: Wanyenze
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D044383:Black People / Q000523:psychology / Q000706:statistics & numerical data; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008403:Mass Screening; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D015995:Prevalence; D036301:Qualitative Research; D057545:Social Stigma; D012944:Social Support
keywords: Fisherfolk; HIV testing; Linkage to care; Uganda