Patients’ perceptions on HIV testing and starting antiretroviral therapy during implementation of universal test and treat

Abstract Introduction Universal Test and Treat (UTT) was introduced to South Africa in 2016 as an HIV prevention and treatment strategy. In this study we aimed to assess the individual perspectives of people living with HIV (PLWH) on starting antiretroviral therapy (ART) during the early implementation of UTT. Methods We conducted a thematic analysis of transcripts from interviews with PLWH who had initiated ART and were enrolled in a randomized controlled trial of point-of-care viral load testing in Durban, South Africa. Results Twenty-five interviews were conducted between March - August 2018,16 (64%) female, 9 (36%) male PLWH, a median age of 30 years. Asymptomatic participants reported needing time to accept their diagnosis and sought shared decision-making discussions with healthcare-providers about starting treatment. Others appreciated the healthcare-provider leading the decision to treatment, which helped them cope with the shock of testing positive. Many participants indicated being happy with starting treatment early as this meant living a normal life and prevented sickness or death. Some saw UTT as an indication that the public healthcare-system cared for them. For those who tested before UTT implementation, some expressed frustrations about being denied treatment due to high CD4 counts. Policymakers had concerns about stigma being a barrier to UTT and adherence, some participants reported that disclosing their status enabled social support which encouraged adherence. Conclusions The implementation of UTT in South Africa has provided a supportive framework for people to understand their diagnosis, accept it and adhere to ART in a caring space.