Multi-level factors affecting entry into and engagement in the HIV continuum of care in Iringa, Tanzania

Multi-Level Factors Affecting Entry into and Engagement in the HIV Continuum of Care in Iringa Tanzania.pdf

Progression through the HIV continuum of care, from HIV testing to lifelong retention in antiretroviral therapy (ART) care and treatment programmes, is critical to the success of HIV treatment and prevention efforts. However, significant losses occur at each stage of the continuum and little is known about contextual factors contributing to disengagement at these stages. 

This study sought to explore multi-level barriers and facilitators influencing entry into and engagement in the continuum of care in Iringa, Tanzania.

Using a mixed-methods study design including facility-based assessments, interviews, focus group discussions and observations, it aims to understand their trajectories in care and treatment. It presents factors influencing engagement at each stage of the continuum:

  • HIV testing and counselling (HTC)
  • linkage to care
  • clinical staging
  • pre-ART care
  • ART 

At each stage in the HIV care continuum, barriers and facilitators at the individual, facility, community, and structural levels were presented in a multi-level continuum of care framework (see image below). Narrative analysis was used to identify the key themes.


Key themes were identified which influenced engagement in HIV services at all levels and these included:

  • the reluctance to engage in HIV services while healthy
  • rigid clinic policies
  • disrespectful treatment from service providers
  • stock-outs of supplies
  • stigma and discrimination
  • alternate healing systems
  • distance to health facilities
  • poverty

These findings highlight the complex, multi-dimensional dynamics that individuals experience throughout the continuum of care and underscore the importance of a holistic and multi-level perspective to understand this process. This study illustrates how multiple barriers interact and influence decisions about engagement in care. Addressing barriers at each level is important to promoting increased engagement throughout the continuum.

Barriers to engagement


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