title: Test and treat: the early experiences in a clinic serving women at high risk of HIV infection in Kampala.
abstract: At the end of 2013, the Government of Uganda issued guidance recommending provision of Anti-Retroviral Treatment (ART) to HIV-positive people in key populations, including female sex workers, regardless of CD4 cell count. We describe the implementation of this new guidance in a clinic serving women at high risk of HIV infection in Kampala. Between July and December 2015, we conducted repeat in-depth interviews with 15 women attending the clinic after the change in guidelines, to explore their perceptions regarding prompt ART initiation. The sample included some women who were HIV-negative and women who had both started and deferred ART. We conducted a data-led thematic analysis of the material from the interviews. A total of 257 of 445 eligible women had started ART; others were undecided or had not returned to the clinic after receiving the new information. Participants recounted varying experiences with the provision of prompt treatment. At an individual level, a history of treatment for opportunistic infections and other illnesses, coupled with relatively poor health, encouraged some to initiate ART promptly. However, knowledge of friends/relatives already on ART who had experienced side effects caused others to delay starting, fearing the same experience for themselves. A number of women questioned why they should start treatment when they were not sick. Situational factors such as work and residence (with many sharing single rooms) caused discomfort among newly diagnosed women who feared disclosure and stigma that would result from taking ART when they were not ill. Alcohol consumption and irregular working hours affected perceptions of future adherence, making prompt ART harder to embrace for some. Our findings show the challenges that influence the delay of treatment initiation, and/or the decision to defer receiving information on ART, with implications for the success of the test and treat programmes and guidelines.
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.
authors.forename: Martin
authors.initials: M
authors.lastname: Mbonye
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.|b London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Janet
authors.initials: J
authors.lastname: Seeley
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.
authors.forename: Ruth
authors.initials: R
authors.lastname: Nalugya
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.
authors.forename: Thadeus
authors.initials: T
authors.lastname: Kiwanuka
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bagiire
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.
authors.forename: Michelle
authors.initials: M
authors.lastname: Mugyenyi
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Namale
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.
authors.forename: Yunia
authors.initials: Y
authors.lastname: Mayanja
authors.affiliation: a MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda.|b London School of Hygiene & Tropical Medicine , London , UK.
authors.forename: Anatoli
authors.initials: A
authors.lastname: Kamali
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010465:Perception; D036301:Qualitative Research; D012306:Risk; D060386:Sex Workers; D057545:Social Stigma; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology
keywords: HIV; Uganda; anti-retroviral treatment; key populations; prompt treatment; test and treat