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Background: ART readiness is a key predictor of ART initiation. However, there is a paucity of data on ART readiness among individuals at the time of HIV-diagnosis and ART eligibility assessment. Under a test-and-treat approach, understanding factors associated with ART readiness can inform strategies to support early engagement in care and thereby maximize the benefits of ART. This study examined demographic and psychosocial factors associated with ART readiness and potential barriers to linkage to care among individuals referred for treatment from a mobile health clinic.
Methods: Between April 2015 and May 2016, 87 individuals (18 years and older) in a resource-limited setting in Cape Town, South Africa, completed a face-to-face survey immediately after referral for ART. ART readiness was assessed using key components of this concept identified in the literature (1) an awareness that treatment will be beneficial; (2) motivation to initiate treatment; and (3) the intention to start treatment soon. Multiple logistic regression analysis, controlling for age, gender and education, identified factors associated with ART readiness.
Results: Most participants were very ready (84%) and motivated (85%) to start ART, but 28% reported some uncertainty regarding ART initiation. Treatment readiness was lower among those surprised by their diagnosis (aOR:0.26,p< 0.05) and among healthier individuals (aOR:0.44,p< 0.01). In contrast, higher readiness was associated with better ART knowledge (aOR:4.31,p< 0.05) and knowing someone who had experienced positive health effects from ART (aOR:2.65,p< 0.05). The three most common self-reported barriers to linking to care were: (1) not wanting to be seen at the clinic (31%); (2) no money for transport (29%); and (3) not being able to get time off work (20%).
Conclusions: Results indicate that post-test counselling will need to be designed to deal with surprise at HIV diagnosis, and that health messaging needs to be carefully crafted for HIV-positive but healthy individuals to improve ART readiness and to increase likelihood of further linkage to treatment and care. Further research is needed on effective post-test counselling approaches (e.g., motivational-interviewing) and effective framing of health messaging to increase awareness of the positive benefits of early ART initiation and corresponding motivation to engage in treatment.