HIV Care Seeking Pathways and Barriers to the Continuum of Care Faced by Persons Living With HIV in Rural Nepal: A Qualitative Study

Background: The Human Immunodeficiency Virus (HIV) has a major impact on a person's social and personal lives, affecting both physical and mental health. To meet the global 95-95-95 target, it is essential to understand and address the multi-level challenges to improve the continuum of care for persons living with HIV (PLWH). This study delves into the care-seeking pathways and barriers encountered by PLWH residing in rural areas of Nepal, shedding light on the complexities of accessing and navigating the continuum of care.

Design: This study was designed as a qualitative thematic study that consisted of in-depth interviews among 21 PLWH and key-informant interviews among four health service providers in rural districts of Koshi province in Nepal. Semi-structured interview guidelines were used to ensure consistency in the data collection process, followed by Inductive Coding to identify and categorize the data into codes. Subsequently, sub-themes and themes were developed, and manifest analysis was conducted to analyze the data. The findings of the study are presented in this paper in the form of excerpts.

Results: The multilevel barriers to HIV care continuum included (i) socio-cultural barriers such as stigma, discrimination, fear of disclosure, and heavy reliance on traditional healers; (ii) socio-economic barriers such as poverty, limited access to health insurance, low health literacy and the exclusion of PLWH under Social Security Act; (iii) fatalistic lifestyles characterized by heavy alcohol consumption, and poor adherence to antiretroviral therapy and (iv) health system-related barriers such as mistreatment by healthcare providers, and long distances to ART centers.

Conclusions: There is a need to expand services beyond treatment, including community-focused awareness and sensitization, programs led by community-based organization, economic empowerment and inclusion of PLWH under social security mechanisms in rural areas for HIV continuum of care.

Patient and public contribution: During the study design phase, two PLWH and two service providers were consulted to discuss the research gap, understand the current practices and discuss the data collection tools and their content. Similarly, four service providers supported implementation of the study and were also consulted to interpret the underlying meaning of the data. One service provider also contributed to the manuscript development process. PLWH and the service providers were also the study participants. The findings of the study are grounded in the data/information provided during the data collection phase, thus meaningfully contributing to this study.