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Editorial
Bottlenecks to HIV care and treatment in sub-Saharan Africa: a multi-country qualitative study
  1. Alison Wringe1,
  2. Jenny Renju1,
  3. Janet Seeley2,7,3,
  4. Mosa Moshabela3,4,
  5. Morten Skovdal5,6
  1. 1 Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
  2. 2 Medical Research Council/Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda
  3. 7 Department of Global Health, London School of Hygiene and Tropical Medicine, London, UK
  4. 3 Africa Health Research Institute, KwaZulu Natal, South Africa
  5. 4 University of KwaZulu Natal, Durban, South Africa
  6. 5 University of Copenhagen, Copenhagen, Denmark
  7. 6 Biomedical Research and Training Institute, Harare, Zimbabwe
  1. Correspondence to Dr Alison Wringe, Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E7HT, UK; alison.wringe{at}lshtm.ac.uk

https://doi.org/10.1136/sextrans-2017-053172

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    The expansion in the provision of life-saving antiretroviral therapy (ART) in sub-Saharan Africa over the past 15 years has been an unprecedented achievement for public health. By the end of 2015, an estimated 10.3 million persons living with HIV (PLHIV) were receiving ART in southern and eastern Africa, the most affected region in the world. Just over half of all PLHIV in the region are now receiving ART, more than double the number just 3 years earlier.1

    ART scale-up has dramatically reduced HIV-related mortality and morbidity, bringing countless social and economic benefits to communities that had been hard hit by the epidemic. The network for Analysing Longitudinal Population data on HIV/AIDS (ALPHA), a collaboration among 10 health and demographic surveillance system (HDSS) sites in east and southern Africa, has been investigating declines in adult mortality and their causes in seven countries (www.lshtm.ac.uk/alpha).2 Recent analyses from seven sites indicate a substantial impact of HIV treatment programmes on adult mortality following the expansion of ART, with declines ranging from 58% to 84%.3

    Despite this progress, there remains a substantial deficit in overall life expectancy among adults living with HIV, with their survival between 5 and 10 years less than among uninfected adults.4 These ‘excess’ deaths among PLHIV are occurring due to late diagnosis, poor linkage to care and treatment, and ART interruptions.5 By the end of 2015, an estimated 44% of PLHIV in southern and eastern Africa remained undiagnosed,6 and rates of linkage to care after diagnosis range widely from 17% to 78%, while ART initiation among those eligible for treatment ranges from 14% to 95%.7 A number of studies have documented reasons for delays in testing, and initiating and adhering to treatment including beliefs that treatment is for people who are sick, fear of side …

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