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Peer-reviewedCC BYBMC public health

Patients' perceptions on HIV testing and starting antiretroviral therapy during implementation of universal test and treat.

  • Upasna Singh1
  • Lindani Msimango1
  • Andrew Gibbs2,3,4
  • Hlengiwe Shozi1
  • Farzana Osman1
  • Yukteshwar Sookrajh5
  • Paul K Drain6,7,8
  • Nigel Garrett1,9
  • Jienchi Dorward10,11
11 affiliations
  1. 1Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
  2. 2Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.
  3. 3Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
  4. 4Department of Psychology, University of Exeter, Exeter, UK.
  5. 5eThekwini Municipality Health Department, Durban, South Africa.
  6. 6Department of Global Health, Schools of Medicine and Public Health, University of Washington, Seattle, USA.
  7. 7Department of Medicine, School of Medicine, University of Washington, Seattle, USA.
  8. 8Department of Epidemiology, School of Public Health, University of Washington, Seattle, USA.
  9. 9Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
  10. 10Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. [email protected].
  11. 11Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. [email protected].
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Abstract

Introduction

Universal Test and Treat (UTT) was introduced to South Africa in 2016 as an HIV prevention and treatment strategy. In this study we aimed to assess the individual perspectives of people living with HIV (PLWH) on starting antiretroviral therapy (ART) during the early implementation of UTT.Methods

We conducted a thematic analysis of transcripts from interviews with PLWH who had initiated ART and were enrolled in a randomized controlled trial of point-of-care viral load testing in Durban, South Africa.Results

Twenty-five interviews were conducted between March - August 2018,16 (64%) female, 9 (36%) male PLWH, a median age of 30 years. Asymptomatic participants reported needing time to accept their diagnosis and sought shared decision-making discussions with healthcare-providers about starting treatment. Others appreciated the healthcare-provider leading the decision to treatment, which helped them cope with the shock of testing positive. Many participants indicated being happy with starting treatment early as this meant living a normal life and prevented sickness or death. Some saw UTT as an indication that the public healthcare-system cared for them. For those who tested before UTT implementation, some expressed frustrations about being denied treatment due to high CD4 counts. Policymakers had concerns about stigma being a barrier to UTT and adherence, some participants reported that disclosing their status enabled social support which encouraged adherence.Conclusions

The implementation of UTT in South Africa has provided a supportive framework for people to understand their diagnosis, accept it and adhere to ART in a caring space.

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Cite

BibTeXRIS
BibTeX
@article{singh2026patients,
  title = {{Patients' perceptions on HIV testing and starting antiretroviral therapy during implementation of universal test and treat.}},
  author = {Upasna Singh and Lindani Msimango and Andrew Gibbs and Hlengiwe Shozi and Farzana Osman and Yukteshwar Sookrajh and Paul K Drain and Nigel Garrett and Jienchi Dorward},
  journal = {BMC public health},
  year = {2026},
  month = aug,
  doi = {10.1186/s12889-026-28876-y},
  url = {https://europepmc.org/article/MED/42972528},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Patients' perceptions on HIV testing and starting antiretroviral therapy during implementation of universal test and treat.
AU  - Upasna Singh
AU  - Lindani Msimango
AU  - Andrew Gibbs
AU  - Hlengiwe Shozi
AU  - Farzana Osman
AU  - Yukteshwar Sookrajh
AU  - Paul K Drain
AU  - Nigel Garrett
AU  - Jienchi Dorward
PY  - 2026
DA  - 2026/08/06
JO  - BMC public health
DO  - 10.1186/s12889-026-28876-y
UR  - https://europepmc.org/article/MED/42972528
AB  - Introduction  Universal Test and Treat (UTT) was introduced to South Africa in 2016 as an HIV prevention and treatment strategy. In this study we aimed to assess the individual perspectives of people living with HIV (PLWH) on starting antiretroviral therapy (ART) during the early implementation of UTT.Methods  We conducted a thematic analysis of transcripts from interviews with PLWH who had initiated ART and were enrolled in a randomized controlled trial of point-of-care viral load testing in Durban, South Africa.Results  Twenty-five interviews were conducted between March - August 2018,16 (64%) female, 9 (36%) male PLWH, a median age of 30 years. Asymptomatic participants reported needing time to accept their diagnosis and sought shared decision-making discussions with healthcare-providers about starting treatment. Others appreciated the healthcare-provider leading the decision to treatment, which helped them cope with the shock of testing positive. Many participants indicated being happy with starting treatment early as this meant living a normal life and prevented sickness or death. Some saw UTT as an indication that the public healthcare-system cared for them. For those who tested before UTT implementation, some expressed frustrations about being denied treatment due to high CD4 counts. Policymakers had concerns about stigma being a barrier to UTT and adherence, some participants reported that disclosing their status enabled social support which encouraged adherence.Conclusions  The implementation of UTT in South Africa has provided a supportive framework for people to understand their diagnosis, accept it and adhere to ART in a caring space.
SN  - 1471-2458
ER  -