Amsterdam 2015
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| Abstract #2308 - Circumcision and TasP: Biomedical interventions | ||||
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Session: 27.6: Circumcision and TasP: Biomedical interventions (Parallel) on Thursday @ 11.30-13.00 in C001 Chaired by Catherine Adams, Fraukje Mevissen Authors: Presenting Author: Ms Eva Vernooij - Amsterdam Institute for Social Science Research, Netherlands |
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| Additional Authors: | ||||
| Aim: The goal of the MaxART Early Access to ART for All implementation study is to evaluate the effectiveness of offering antiretroviral treatment for prevention in a government-managed health system in Swaziland. The study is implemented in 14 rural health facilities which is expected to provide evidence of the feasibility, acceptability, scalability, and outcomes of initiating all individuals diagnosed HIV positive on ART irrespective of CD4 count, viral load or clinical stage of the disease. Prior to the start of the implementation study a qualitative situational analysis was conducted with healthcare providers, clients recently diagnosed HIV positive and people living with HIV who are members of support groups, to examine their perspectives of how antiretroviral therapy works as a prevention method, what they see as the advantages and disadvantages of early treatment initiation, and how they propose that the prevention potential of treatment be explained in counseling sessions. | ||||
| Method / Issue: Data collection took place between April and June 2013 in eight different health facilities and surrounding communities in two different regions in Swaziland. Semi-structured interviews were carried out with 71 HIV service providers involved in HIV care and treatment (clinicians, nurses, counselors, expert clients). Furthermore 30 pre- and post-test counselling sessions and 25 pre-ART counselling sessions were observed, and 34 people living with HIV (12 men 22 women) who are clients at the sampled health facilities were interviewed. Finally eight focus group discussions were held with people living with HIV (N=84) who were members of support groups. Data was analysed using NVivo 10 software. | ||||
| Results / Comments: The message that starting ART earlier has prevention benefits is received with mixed reactions by both healthcare providers and clients. While about two-thirds (68%) of the providers interviewed responded ‘yes’ to the question “Do you think clients should be told about prevention benefit of ART?”, if probed about how exactly they would explain prevention benefits hardly anyone mentioned the prevention benefits. Common fears among providers about TasP were that clients would misinterpret the message of ARVs reducing the risk of transmission to mean zero risk, and that it would lead to increases in condom-less sex and promiscuity. Observations from counseling sessions indicate that condom use is the main prevention message given to both HIV negative and positive clients. HIV positive clients are told to use condoms, regardless of whether their partner is also HIV positive and/or whether they are on ART, to avoid re-infection with different HIV strains as well as to prevent STIs and pregnancy. Furthermore, condom use is promoted to prevent the CD4 count from ping: “They told me that I should no longer practice unprotected sex but use a condom and maybe only have sex twice a month so that my CD4 count won’t .” (Male client, duration HIV status known: 3.5 years, CD4 count: 608). | ||||
| Discussion: Our study findings revealed that current HIV prevention messages, institutional cultures of HIV service provision and providers’ opinions affect the implementation and potential effectiveness of a TasP strategy. Far from being tacitly compliant with the move towards TasP, our findings demonstrate ethical challenges faced by front-line service providers who feel uneasy talking about prevention benefits of ART. | ||||
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