Exploring Relationship Factors and Engagement in HIV Care in South Africa
South Africa's HIV/AIDS epidemic is among the largest in the world in terms of its breadth and consequences. Despite rapid expansions in antiretroviral therapy (ART), a large number of HIV-positive individuals remain disengaged in care and treatment after diagnosis. In sub-Saharan Africa, relationship dynamics play an important role on HIV-related behavior, however, it is unclear how these factors affect decision-making along the treatment cascade. Successful design and implementation of couple-based approaches to increase engagement in HIV care is dependent upon our understanding of how treatment behaviors are shaped at the relationship level. Thus, the primary objective of this study is to explore how relationship characteristics and dynamics may affect engagement in HIV care, including linkage into care, retention in care, ART initiation, and ART adherence. A secondary objective of this study is to specifically analyze the gender differences in patterns of influence on engagement in HIV care. To accomplish these aims, we will conduct an in-depth qualitative study with couples in which at least one partner is HIV-positive and has disclosed. By leveraging the resources of an ongoing couple-based intervention in Vulindlela, South Africa, we will recruit HIV-positive individuals and their partners from clinical venues with whom we have established relationships. The qualitative data will be analyzed inductively for recurrent patterns of relationship and partner influences on the engagement in HIV care. This project will be conducted over a 12-month period starting in February of 2014. The findings will provide preliminary data for a larger quantitative study to test for statistical associations between the factors identified and use of HIV care at different stages. Longer term plans for this proposed line of research will be to inform and develop a couples-based intervention to increase engagement in HIV care in South Africa.