Barriers and facilitators to implementation of Universal Test and Treat in iLembe District, KwaZulu-Natal province: A qualitative study of healthcare workers’ perspectives

Abstract

Background: South Africa adopted the Universal Test and Treat (UTT) policy in 2016 to accelerate progress towards achieving the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90–90–90 targets, which were later revised to UNAIDS 95–95–95 targets. However, implementation challenges have persisted with the iLembe District only achieving targets of 97–73–86 in 2024/2025. Objectives: The aim of this study was to explore the healthcare workers’ perspectives on the barriers and facilitators to the effective implementation of the UTT HIV policy in iLembe District in KwaZulu-Natal (KZN). Method: A qualitative, exploratory study was conducted across four clinics (rural, semi-urban and urban), with 12 professional nurses with ≥ 3 years’ experience in HIV care participating in face-to-face, semi-structured interviews. Audio-recorded interviews were transcribed verbatim and analysed deductively based on stakeholder involvement and WHO health systems building blocks. Results: Five predetermined categories – stakeholder involvement, service delivery, leadership, health workforce and medicines, infrastructure and equipment – were tested as barriers and facilitators to the UTT implementation in the iLembe District. Conclusion: Stakeholder involvement and adequate resources (human and other) to implement the UTT policy are an ongoing challenges to effective UTT implementation. Addressing these can help the iLembe District increase the number of new HIV tests, repeat tests and antiretroviral therapy initiations.