Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland

M. Molemans, E. Vernooij, N. Dlamini, F.S. Shabalala, S. Khan, F. van Leth, G.B. Gomez, R. Reis

Research output: Contribution to JournalArticleAcademicpeer-review


© 2019 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.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.
Original languageEnglish
Pages (from-to)563-570
JournalTropical Medicine and International Health
Issue number5
Publication statusPublished - 1 May 2019
Externally publishedYes


We thank Anita Hardon for her contributions to the design and her institutional support to this study, Christopher Pell for his supervisory assistance, Nombulelo Simelane for her support with data collection during the early stages of the study, Nelisiwe Masilela and other research assistants for their support during the end stages of data collection. We also thank the MaxART partners, EAAA study team, healthcare providers and patients at EAAA study sites for their cooperation during the study. The MaxART consortium received support of the Dutch Postcode Lottery in the Netherlands, the Embassy of the Kingdom of the Netherlands in South Africa/Mozambique, British Colombia Centre of Excellence in HIV/AIDS in Canada, Mylan and Médecins Sans Frontières. The findings and analysis presented are those of the authors and do not reflect those of any funders.

FundersFunder number
British Colombia Centre of Excellence in HIV/AIDS in Canada
Mylan and Médecins Sans Frontières
Nelisiwe Masilela


    Dive into the research topics of 'Changes in disclosure, adherence and healthcare interactions after the introduction of immediate ART initiation: an analysis of patient experiences in Swaziland'. Together they form a unique fingerprint.

    Cite this