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"I take my pills every day, but then it goes up, goes down. I don't know what's going on": perceptions of HIV virological failure in a rural context in Mozambique. A qualitative research study. / Tarquino, Ivan Alejandro Pulido; Venables, Emilie; Fidelis, Jose Manuel de Amaral; Giuliani, Ruggero; Decroo, Tom.

In: PLoS ONE, Vol. 14, Nr. 6, 0218364, 2019.

Onderzoeksoutput: Bijdrage aan tijdschriftA1: Web of Science-artikelOnderzoekpeer review

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Tarquino, Ivan Alejandro Pulido ; Venables, Emilie ; Fidelis, Jose Manuel de Amaral ; Giuliani, Ruggero ; Decroo, Tom. / "I take my pills every day, but then it goes up, goes down. I don't know what's going on": perceptions of HIV virological failure in a rural context in Mozambique. A qualitative research study. In: PLoS ONE. 2019 ; Vol. 14, Nr. 6.

BibTeX

@article{7544f65939694b13beb55d3120893a11,
title = "{"}I take my pills every day, but then it goes up, goes down. I don't know what's going on{"}: perceptions of HIV virological failure in a rural context in Mozambique. A qualitative research study",
abstract = "BackgroundHIV prevalence in Mozambique is estimated to be 13.2{\%}. Routine viral load for HIV monitoring was first implemented in the rural area of Tete in 2014. Programmatic data showed an unexpected high proportion of high viral load results, with up to 40{\%} of patients having a viral load above 1000 copies/ml.ObjectivesThis qualitative study aimed to explore perceptions about virological failure and viral load monitoring from the perspective of HIV positive patients on first-line antiretroviral therapy (ART) and health-care workers.MethodsThe study was conducted in seven rural communities in Changara-Marara district, Tete province, Mozambique. A total of 91 participants took part in in-depth interviews (IDIs) and focus group discussions (FGDs), including health-care workers (n = 18), patients on ART in individual care or Community Adherence Groups (CAGs) who experienced virological failure and virological re-suppression (n = 39) and CAG focal points (n = 34). Purposive sampling was used to select participants. Interviews and FGDs were conducted in Nhuengue and Portuguese. IDIs and FGDs were translated and transcribed before being coded and thematically analysed.ResultsEmergent themes showed that patients and health-care workers attributed great importance to viral load monitoring. A supressed viral load was viewed by participants as a predictor of good health and good adherence. However, some patients were confused and appeared distressed when confronted with virological failure. Viral load results were often little understood, especially when virological failure was detected despite good adherence. Inadequate explanations of causes of virological failure, delayed follow-up viral load results, repeated blood tests and lack of access to second-line ART resulted in reduced confidence in the effectiveness of ART, challenged the patient-provider relationship and disempowered patients and providers.ConclusionIn this rural context undetectable viral load is recognized as a predictor of good health by people living with HIV and health-care workers. However, a lack of knowledge and health system barriers caused different responses in patients and health-care workers. Adapted counselling strategies, accelerated viral load follow-up and second-line ART initiation in patients with virological failure need to be prioritized.",
keywords = "MIDDLE-INCOME COUNTRIES, ANTIRETROVIRAL THERAPY, RISK-FACTORS, VIRAL LOAD, ADHERENCE, OUTCOMES",
author = "Tarquino, {Ivan Alejandro Pulido} and Emilie Venables and Fidelis, {Jose Manuel de Amaral} and Ruggero Giuliani and Tom Decroo",
note = "CPDF",
year = "2019",
doi = "10.1371/journal.pone.0218364",
language = "English",
volume = "14",
journal = "PLoS ONE",
issn = "1932-6203",
publisher = "Public Library of Science",
number = "6",

}

RIS

TY - JOUR

T1 - "I take my pills every day, but then it goes up, goes down. I don't know what's going on": perceptions of HIV virological failure in a rural context in Mozambique. A qualitative research study

AU - Tarquino, Ivan Alejandro Pulido

AU - Venables, Emilie

AU - Fidelis, Jose Manuel de Amaral

AU - Giuliani, Ruggero

AU - Decroo, Tom

N1 - CPDF

PY - 2019

Y1 - 2019

N2 - BackgroundHIV prevalence in Mozambique is estimated to be 13.2%. Routine viral load for HIV monitoring was first implemented in the rural area of Tete in 2014. Programmatic data showed an unexpected high proportion of high viral load results, with up to 40% of patients having a viral load above 1000 copies/ml.ObjectivesThis qualitative study aimed to explore perceptions about virological failure and viral load monitoring from the perspective of HIV positive patients on first-line antiretroviral therapy (ART) and health-care workers.MethodsThe study was conducted in seven rural communities in Changara-Marara district, Tete province, Mozambique. A total of 91 participants took part in in-depth interviews (IDIs) and focus group discussions (FGDs), including health-care workers (n = 18), patients on ART in individual care or Community Adherence Groups (CAGs) who experienced virological failure and virological re-suppression (n = 39) and CAG focal points (n = 34). Purposive sampling was used to select participants. Interviews and FGDs were conducted in Nhuengue and Portuguese. IDIs and FGDs were translated and transcribed before being coded and thematically analysed.ResultsEmergent themes showed that patients and health-care workers attributed great importance to viral load monitoring. A supressed viral load was viewed by participants as a predictor of good health and good adherence. However, some patients were confused and appeared distressed when confronted with virological failure. Viral load results were often little understood, especially when virological failure was detected despite good adherence. Inadequate explanations of causes of virological failure, delayed follow-up viral load results, repeated blood tests and lack of access to second-line ART resulted in reduced confidence in the effectiveness of ART, challenged the patient-provider relationship and disempowered patients and providers.ConclusionIn this rural context undetectable viral load is recognized as a predictor of good health by people living with HIV and health-care workers. However, a lack of knowledge and health system barriers caused different responses in patients and health-care workers. Adapted counselling strategies, accelerated viral load follow-up and second-line ART initiation in patients with virological failure need to be prioritized.

AB - BackgroundHIV prevalence in Mozambique is estimated to be 13.2%. Routine viral load for HIV monitoring was first implemented in the rural area of Tete in 2014. Programmatic data showed an unexpected high proportion of high viral load results, with up to 40% of patients having a viral load above 1000 copies/ml.ObjectivesThis qualitative study aimed to explore perceptions about virological failure and viral load monitoring from the perspective of HIV positive patients on first-line antiretroviral therapy (ART) and health-care workers.MethodsThe study was conducted in seven rural communities in Changara-Marara district, Tete province, Mozambique. A total of 91 participants took part in in-depth interviews (IDIs) and focus group discussions (FGDs), including health-care workers (n = 18), patients on ART in individual care or Community Adherence Groups (CAGs) who experienced virological failure and virological re-suppression (n = 39) and CAG focal points (n = 34). Purposive sampling was used to select participants. Interviews and FGDs were conducted in Nhuengue and Portuguese. IDIs and FGDs were translated and transcribed before being coded and thematically analysed.ResultsEmergent themes showed that patients and health-care workers attributed great importance to viral load monitoring. A supressed viral load was viewed by participants as a predictor of good health and good adherence. However, some patients were confused and appeared distressed when confronted with virological failure. Viral load results were often little understood, especially when virological failure was detected despite good adherence. Inadequate explanations of causes of virological failure, delayed follow-up viral load results, repeated blood tests and lack of access to second-line ART resulted in reduced confidence in the effectiveness of ART, challenged the patient-provider relationship and disempowered patients and providers.ConclusionIn this rural context undetectable viral load is recognized as a predictor of good health by people living with HIV and health-care workers. However, a lack of knowledge and health system barriers caused different responses in patients and health-care workers. Adapted counselling strategies, accelerated viral load follow-up and second-line ART initiation in patients with virological failure need to be prioritized.

KW - MIDDLE-INCOME COUNTRIES

KW - ANTIRETROVIRAL THERAPY

KW - RISK-FACTORS

KW - VIRAL LOAD

KW - ADHERENCE

KW - OUTCOMES

U2 - 10.1371/journal.pone.0218364

DO - 10.1371/journal.pone.0218364

M3 - A1: Web of Science-article

VL - 14

JO - PLoS ONE

T2 - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

IS - 6

M1 - 0218364

ER -

ID: 3061006