The perspectives of key informants on programs and policies pertaining to HIV prevention and treatment for farm workers in rural South Africa

Abstract

Introduction: Farm workers are one of the subpopulations with poor progress toward the 95-95-95 targets in South Africa. The transient nature of farm workers results in treatment disruptions and affects the continuity of care. This study aimed to explore program implementers’ and program experts’ perspectives on the challenges and opportunities in providing HIV prevention and care to people working on farms. Methods: The study was conducted in three provinces of South Africa, using an exploratory qualitative study design. Policy document analysis was performed followed by key informant interviews with HIV program implementers and program experts. Key informants were purposively selected based on their roles in the HIV program at health facilities and other settings. An inductive approach was used to analyze data. Results: Eight policy documents were analyzed, and eight key informants were interviewed. Emerging themes included challenges in providing HIV services to farm workers, effective strategies employed by service providers, and program and policy recommendations. Several challenges in providing HIV care to farm workers were presented, including their high mobility which leads to treatment interruptions and loss to follow-up. As a result, farm workers easily get lost to follow-up and are likely to have poor treatment outcomes. Some of the effective strategies included community-based prevention, treatment and support services, and the use of health passports to improve linkages to care. Community health workers, mobile clinics, and community-based pick-up points improve access to HIV counselling and testing, adherence to antiretroviral therapy, and retention in care. Program and policy recommendations included customized HIV services and designing sector-specific HIV policies. Conclusion: The study reveals ongoing structural barriers that limit sufficient HIV prevention and retention in care for farm workers who are on treatment. Models of care that include patient-held records, workplace-provided services, and mobile healthcare are recommended.