Barriers and Facilitators to Antiretroviral Therapy in Northern Tanzania in the Era of Test and Treat

Abstract Background Tanzania adopted WHO’s universal test and treat policy in 2016, recommending antiretroviral therapy (ART) for all people living with HIV (PLHIV). However, many individuals continue to confront challenges initiating or continuing ART. The study aims to understand how barriers and facilitators to ART have evolved since Test and Treat policy in Tanzania.Between March and June 2018, 25 semi-structured in-depth interviews were conducted among PLHIV who were out of care, including PLHIV who never initiated ART and PLHIV who were formerly in care and discontinued ART. Participants were 18-years-old or older, identified from clinic databases at three health facilities and through home-based care providers. Data were coded and interpreted using content analysis and the socio-ecological framework.Results Low HIV literacy, poor quality of health messaging and comprehension, stigma, structural factors, and poverty were identified as main barriers to care. HIV literacy appeared higher among those formerly in care and some misconceptions about ART differed whether or not participants had previously initiated treatment. Participants expressed desire for more information about their health and treatment, including more engagement with their healthcare providers. Conclusions Our results are consistent with the barriers and facilitators to care reported prior to the implementation of the Test and Treat policy. Despite universal access to care, limited progress has been made in addressing the underlying challenges that PLHIV confront in initiating and continuing ART. Efforts such as increase in HIV literacy, improve health messaging, and strengthen healthcare provider-to-patient communication will facilitate access to care. The policy implication of these findings is that the landscape for barriers to ART has not changed drastically, efforts towards engagement to care need to be further refined and tailored to facilitate access to care.