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Introduction: There are concerns that immediate ART initiation (regardless of CD4 count) negatively affects HIV status disclosure, ART adherence and healthcare interactions. We assessed changes in these factors after the 'Early access to ART for all' intervention, a universal test-and-treat study in Swaziland.Methods: We recruited two samples of participants between 2014 and 2017. The first group was interviewed before the intervention (control); the second group at the implementation and 6 months thereafter (intervention).Results: High levels of disclosure to partners (controls and intervention: 94%) and family members (controls: 78%, intervention: 79%) were reported, and high levels of adherence (85% did not miss a dose among the controls, 84% in the intervention group). There were no changes in patients reporting feeling pressured to initiate ART (controls: 10%, intervention: 11%). The quality of interaction with healthcare workers improved after the intervention; healthcare workers explained more often the choice of ART initiation (controls: 88%, intervention: 93%) and the meaning of both CD4 and viral load test results (controls: 15%, intervention: 47%). More patients in the intervention group reported receiving test results (controls: 13%, intervention: 46%). We observed no changes in disclosure, adherence or patient experiences 6 months into the intervention compared to its start.Conclusion: Our results suggest that both reported adherence and disclosure levels remain high after the introduction of immediate ART in Swaziland. We observed an improvement in the healthcare interactions, possibly due to training at participating facilities, which will be an important element for a successful roll-out of immediate ART. [ABSTRACT FROM AUTHOR]

Introduction Universal test and treat (UTT)—antiretroviral therapy (ART) for all HIV-positive individuals regardless of CD4 count—is the WHO's recommended treatment guideline. UTT has implications for health providers' workload in areas of high HIV prevalence and for understandings of ART and HIV. This article explores health providers' experiences of implementing UTT in Hhohho Region, Eswatini. Methods Between March 2015 and October 2016, in-depth interviews were conducted with health providers implementing UTT. Interviews were transcribed verbatim and translated into English for qualitative content analysis. Results Twenty-five providers from eight facilities were interviewed. Respondents encouraged early ART by promoting its overall health benefits, and the possibility of avoiding disclosure and HIV-related stigma in the community. Some health providers downplayed UTT's preventive benefits to avoid discouraging condom use. Respondents suggested that initiating ART immediately after testing could improve linkage-to-care, but recognized that overly hasty initiation might affect adherence. Viral load testing was seen as a potentially useful tool to monitor clients' response to ART. Conclusions Health providers appropriated stigma to encourage early ART. This suggests an attentiveness to the social burden of HIV/AIDS, but potentially exacerbates discrimination and conflicts with efforts to reduce HIV-related stigma. [ABSTRACT FROM AUTHOR]

Background: Test and start, antiretroviral therapy (ART) for all HIV-positive individuals, is a WHO-recommended treatment guideline. In Swaziland, test and start has been evaluated through the MaxART implementation study. This article examines why, in MaxART, some newly diagnosed HIV-positive clients delayed initiating ART. Methods: Thirteen HIV-positive clients who delayed ART for =90 d after testing were identified from the MaxART study database and interviewed. Interviews were audio recorded, transcribed and translated into English for qualitative content analysis. Results: Respondents had often tested positive several times before initiating ART, with the initial diagnosis sometimes completely unexpected. Repeat testing--and delayed ART--was linked to a desire to come to terms with their diagnosis and prepare for a lifelong treatment course. Clients previously enrolled in pre-ART, particularly with high CD4 counts, had internalized past messages about ART as being non-essential and taking care of oneself through other means. Concerns about ART-related adverse events were weighed against these messages. Worries about inadvertent disclosure and its impact on social and economic relationships also discouraged initiation. Conclusion: Although potentially reducing logistical barriers, expedited ART initiation does not necessarily accommodate some clients' need for time to come to terms with the diagnosis and the prospect of lifelong treatment. [ABSTRACT FROM AUTHOR]