Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.

In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was...

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Autores principales:	Dam Anh Tran, Anthony Shakeshaft, Anh Duc Ngo, John Rule, David P Wilson, Lei Zhang, Christopher Doran
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/95e1622f634b4f6cb5b8217892d720f3
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spelling	oai:doaj.org-article:95e1622f634b4f6cb5b8217892d720f32021-11-18T08:05:35ZStructural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.1932-620310.1371/journal.pone.0051289https://doaj.org/article/95e1622f634b4f6cb5b8217892d720f32012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23240013/?tool=EBIhttps://doaj.org/toc/1932-6203In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was undertaken in six clinics from five provinces in Vietnam. Baseline CD4 counts were collected from patient records and grouped into three categories: very late initiators (≤100 cells/mm(3) CD4), late initiators (100-200 cells/mm(3)) and timely initiators (200-350 cells/mm(3)). Thirty in-depth interviews with patients who started ART and 15 focus group discussions with HIV service providers were conducted and thematic analysis of the content performed. Of 934 patients, 62% started ART very late and 11% initiated timely treatment. The proportion of patients for whom a CD4 count was obtained within six months of their HIV diagnosis ranged from 22% to 72%. The proportion of patients referred to ART clinics by voluntary testing and counselling centres ranged from 1% to 35%. Structural barriers to timely ART initiation were poor linkage between HIV testing and HIV care and treatment services, lack of patient confidentiality and a shortage of HIV/AIDS specialists. If Vietnam's treatment practice is to align with WHO recommendations then the connection between voluntary counselling and testing service and ART clinics must be improved. Expansion and decentralization of HIV/AIDS services to allow implementation at the community level increased task sharing between doctors and nurses to overcome limited human resources, and improved patient confidentiality are likely to increase timely access to HIV treatment services for more patients.Dam Anh TranAnthony ShakeshaftAnh Duc NgoJohn RuleDavid P WilsonLei ZhangChristopher DoranPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 12, p e51289 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Dam Anh Tran Anthony Shakeshaft Anh Duc Ngo John Rule David P Wilson Lei Zhang Christopher Doran Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.
description	In Vietnam, premature mortality due to AIDS-related conditions is commonly associated with late initiation to antiretroviral therapy (ART). This study explores reasons for late ART initiation among people living with HIV (PLHIV) from the perspectives of health care providers and PLHIV. The study was undertaken in six clinics from five provinces in Vietnam. Baseline CD4 counts were collected from patient records and grouped into three categories: very late initiators (≤100 cells/mm(3) CD4), late initiators (100-200 cells/mm(3)) and timely initiators (200-350 cells/mm(3)). Thirty in-depth interviews with patients who started ART and 15 focus group discussions with HIV service providers were conducted and thematic analysis of the content performed. Of 934 patients, 62% started ART very late and 11% initiated timely treatment. The proportion of patients for whom a CD4 count was obtained within six months of their HIV diagnosis ranged from 22% to 72%. The proportion of patients referred to ART clinics by voluntary testing and counselling centres ranged from 1% to 35%. Structural barriers to timely ART initiation were poor linkage between HIV testing and HIV care and treatment services, lack of patient confidentiality and a shortage of HIV/AIDS specialists. If Vietnam's treatment practice is to align with WHO recommendations then the connection between voluntary counselling and testing service and ART clinics must be improved. Expansion and decentralization of HIV/AIDS services to allow implementation at the community level increased task sharing between doctors and nurses to overcome limited human resources, and improved patient confidentiality are likely to increase timely access to HIV treatment services for more patients.
format	article
author	Dam Anh Tran Anthony Shakeshaft Anh Duc Ngo John Rule David P Wilson Lei Zhang Christopher Doran
author_facet	Dam Anh Tran Anthony Shakeshaft Anh Duc Ngo John Rule David P Wilson Lei Zhang Christopher Doran
author_sort	Dam Anh Tran
title	Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.
title_short	Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.
title_full	Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.
title_fullStr	Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.
title_full_unstemmed	Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.
title_sort	structural barriers to timely initiation of antiretroviral treatment in vietnam: findings from six outpatient clinics.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/95e1622f634b4f6cb5b8217892d720f3
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Structural barriers to timely initiation of antiretroviral treatment in Vietnam: findings from six outpatient clinics.

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