AIDS and Behavior

, Volume 22, Issue 8, pp 2543–2552 | Cite as

Exploring Treatment Needs and Expectations for People Living with HIV in South Africa: A Qualitative Study

  • Valerie A. Earnshaw
  • Laura M. Bogart
  • Ingrid Courtney
  • Holly Zanoni
  • David R. Bangsberg
  • Catherine Orrell
  • Kathy Goggin
  • Ingrid T. Katz
Original Paper


The UNAIDS 90-90-90 treatment targets aim to dramatically increase the number of people who initiate antiretroviral therapy (ART) by 2020. Greater understanding of barriers to ART initiation in high prevalence countries like South Africa is critical. Qualitative semi-structured interviews were conducted with 30 participants in Gugulethu Township, South Africa, including 10 healthcare providers and 20 people living with HIV (PLWH) who did not initiate ART. Interviews explored barriers to ART initiation and acceptability of theory-based intervention strategies to optimize ART initiation. An inductive content analytic approach was applied to the data. Consistent with the Theory of Triadic Influence, barriers to ART initiation were identified at the individual, social, and structural levels. Results suggested high acceptability for intervention strategies involving trained HIV-positive peers among South African PLWH and healthcare providers. Research is needed to evaluate their feasibility and efficacy in high HIV prevalence countries.


HIV Antiretroviral therapy Qualitative South Africa 


Los objetivos de tratamiento de UNAIDS 90-90-90 apuntan a aumentar drásticamente el número de personas que inician la terapia antirretroviral (TAR) para el año 2020. Es fundamental comprender mejor las barreras al inicio del TAR en países de alta prevalencia como Sudáfrica. Se realizaron entrevistas semiestructuradas cualitativas, con 30 participantes en el municipio de Gugulethu, Sudáfrica, incluyendo 10 proveedores de atención médica y 20 personas que viven con el VIH que no iniciaron el tratamiento antirretroviral. Las entrevistas exploraron las barreras al inicio del TAR y la aceptabilidad de las estrategias de intervención basadas en la teoría para optimizar el inicio del TAR. Se aplicó un enfoque analítico de contenido inductivo a los datos. De acuerdo con la Teoría de la Influencia Triádica, las barreras a la iniciación de TAR fueron identificadas a nivel individual, social y estructural. Los resultados sugirieron una alta aceptabilidad para las estrategias de intervención que involucran a compañeros capacitados VIH-positivos entre las personas que viven con el VIH y los proveedores de atención médica sudafricanos. Se necesita investigación para evaluar su viabilidad y eficacia en países de alta prevalencia del VIH.



This study would not have been possible without the dedication of the study participants. The authors thank Ismael Medina for translating the abstract of this article into Spanish.


This publication was made possible with funding from the U.S. National Institute on Drug Abuse K01 DA042881 (Earnshaw); the U.S. National Institute for Mental Health R34 MH108393 (Katz); the Burke Global Health Fellowship, Harvard Global Health Institute (Katz); and the Center for HIV Identification, Prevention, and Treatment (CHIPTS) National Institute for Mental Health Grant P30 MH58107 (Bogart). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Human Development and Family SciencesUniversity of DelawareNewarkUSA
  2. 2.RAND CorporationSanta MonicaUSA
  3. 3.Desmond Tutu HIV Centre, IDM and Department of MedicineUniversity of Cape TownCape TownSouth Africa
  4. 4.Department of MedicineBrigham and Women’s HospitalBostonUSA
  5. 5.Oregon Health & Science University-Portland State University School of Public HealthPortlandUSA
  6. 6.Health Services and Outcomes ResearchChildren’s Mercy Kansas CityKansas CityUSA
  7. 7.University of Missouri - Kansas City Schools of Medicine and PharmacyKansas CityUSA
  8. 8.Harvard Medical SchoolBostonUSA
  9. 9.Center for Global Health, Massachusetts General HospitalBostonUSA

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