Imperial College London


Faculty of MedicineSchool of Public Health

Professor of Public Health



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158Norfolk PlaceSt Mary's Campus






BibTex format

author = {Bruton, PJ and Rai, T and Day, S and Ward, H},
doi = {10.1136/bmjopen-2017-020208},
journal = {BMJ Open},
title = {Patient perspectives on the HIV continuum of care in London: a qualitative study of people diagnosed between 1986 and 2014},
url = {},
volume = {8},
year = {2018}

RIS format (EndNote, RefMan)

AB - Objectives: To describe the experiences of the HIV treatment cascade of diagnosis, engagement with care and initiation of treatment, from the perspective of patients; we explored whether this differed according to the year of their diagnosis, for example whether they had experienced HIV care in the pre-treatment era.Design: Qualitative interview study with framework analysisSetting: Two large HIV adult outpatient clinics in central London. Participants: 52 HIV positive individuals, 41 men, 11 women, purposively sampled to include people who had been diagnosed at different stages in the history of the epidemic classified as four ‘generations’: pre-1996 (pre-ART), 1997 to 2005 (complex ARTs), 2006 to 2012 (simpler ARTs), 2013 onwards (recent diagnoses).Results: Some important differences were identified; for earlier generations, the visible illness and deaths from AIDS made it harder to engage with care following diagnosis. Subsequent decisions about starting treatment were deeply influenced by the fear of severe side-effects from early antiretroviral therapy (ART). However, despite improvements in ART and life expectancy over the epidemic we found a striking similarity across participants’ accounts of the key stages of the care continuum, regardless of when they were diagnosed. Diagnosis was a major traumatic life event for almost everyone, fear of testing positive or having low self-perceived risk affected the timing of testing and diagnosis, engaging with care was facilitated by a flexible approach from services/clinicians and initiating treatment was a major life decision. Conclusion: We found patients’ experiences are influenced by when they were diagnosed, with earliest cohorts facing substantial challenges. However, being diagnosed with HIV and starting treatment continue to be significant life-altering events even in the era of effective, simple treatments. Despite the advances of biomedical treatment services should continue to recogn
AU - Bruton,PJ
AU - Rai,T
AU - Day,S
AU - Ward,H
DO - 10.1136/bmjopen-2017-020208
PY - 2018///
SN - 2044-6055
TI - Patient perspectives on the HIV continuum of care in London: a qualitative study of people diagnosed between 1986 and 2014
T2 - BMJ Open
UR -
UR -
VL - 8
ER -