COVID-19 may Exacerbate the Clinical, Structural and Psychological Barriers to Retention in Care Among Women Living with HIV in Rural and Peri-Urban Settings in Uganda

Abstract

Abstract; Background: Retention of pregnant and breastfeeding women and their infants in HIV care still remains low in Uganda yet it is critical in achieving elimination of mother to child transmission of HIV. A research program was undertaken to locate disengaged HIV positive women on Option B+ and supported them to reengage in care. A one year follow up done following the tracing revealed that some women still disengaged from care. We aimed to establish the barriers to and facilitators for reengagement in care among previously traced women on option B+, and how these could have been impacted by the COVID-19 pandemic. Methods: This was a cross sectional qualitative study using individual interviews conducted in June and July, 2020, a period when the COVID-19 response measures such as lockdown and restrictions on transport were being observed in Uganda. Study participants were drawn from nine peri-urban and rural public healthcare facilities. Purposive sampling was used to select women still engaged in and those who disengaged from care approximately after one year since they were last contacted. Data was analysed using the content analysis approach. Results: Seventeen participants were included. Women reported various barriers that affected their reengagement and retention in care during the COVID-19 pandemic. These included structural barriers such as transport difficulties and financial constraints; clinical barriers which included unsupportive healthcare workers, short supply of drugs, clinic delays, lack of privacy and medicine side effects; and psychosocial barriers such as perceived or experienced stigma and non-disclosure of HIV sero-status. Supportive structures such as family, community-based medicine distribution models, and a friendly healthcare environment were key facilitators to retention in care among this group. The COVID-19 pandemic was reported to exacerbate the barriers to retention in care. Conclusions: Women previously at risk of disengagement may have more chances of dropping out from care during the COVID-19. We recommend community-based models such as drop out centres, peer facilitated distribution and community outreaches as alternative measures for access to ART during the COVID-19 and other pandemics that spread through close contact.