{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T18:48:54Z","timestamp":1785523734806,"version":"3.56.0"},"reference-count":71,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T00:00:00Z","timestamp":1785456000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Decentralization of antiretroviral therapy (ART) brought treatment to millions of people in Sub-Saharan Africa. However, the implications of such decentralization are still not fully understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study included 60 semi-structured interviews with community leaders, healthcare providers, patients, and community members served by a rural mission hospital in Zimbabwe, conducted in January-March 2019. Interviews were transcribed and translated into English and coded using an iterative codebook. Coded extracts were grouped into themes and categories, systematically using QDA Miner qualitative analysis software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>The study reveals that treatment-for-all policies and decentralization of ART have indeed improved access to care (as experienced by the study participants). However, the study shows that these policies also had unintended negative consequences. Stigma and complex social relations significantly affect the practices and experiences of ART outreach care, for both patients and healthcare providers, and may hamper attempts to reduce stigma as well as increase physical and social barriers to accessing ART.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study\u2019s results highlight the need to understand the consequences of the decentralization of HIV care, as well as the barriers and facilitators associated with ART outreach in order to improve quality of care and provide true accessibility to HIV care for all.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354747","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T17:27:56Z","timestamp":1785518876000},"page":"e0354747","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mixed feelings: Unintended consequences of HIV outreach care in Zimbabwe"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-3647-065X","authenticated-orcid":true,"given":"Noa","family":"Gluskinos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Maposhere","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ushehwedu","family":"Kufakurinani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Godfrey","family":"Hove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathy","family":"McCarty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Katzenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4641-6645","authenticated-orcid":true,"given":"Anat","family":"Rosenthal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,31]]},"reference":[{"key":"pone.0354747.ref001","volume-title":"90-90-90 An ambitious treatment target to help end the AIDS epidemic","author":"UNAIDS","year":"2014"},{"issue":"6","key":"pone.0354747.ref002","article-title":"Decentralising HIV treatment in lower- and middle-income countries","volume":"2013","author":"T Kredo","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"issue":"7","key":"pone.0354747.ref003","article-title":"HIV knowledge trends during an era of rapid antiretroviral therapy scale-up: an analysis of 33 sub-Saharan African countries","volume":"21","author":"BT Chan","year":"2018","journal-title":"J Int AIDS Soc"},{"issue":"4","key":"pone.0354747.ref004","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1080\/01459740.2013.802319","article-title":"Treatment literacy, therapeutic efficacy, and antiretroviral drugs: notes from Bushbuckridge, South Africa","volume":"33","author":"I Niehaus","year":"2013","journal-title":"Med Anthropol"},{"issue":"2","key":"pone.0354747.ref005","first-page":"79","article-title":"Providing anti-retroviral therapy in the context of self-perceived stigma: a mixed methods study from Tanzania","volume":"16","author":"EAM Tarimo","year":"2014","journal-title":"Tanzan J Health Res"},{"issue":"8","key":"pone.0354747.ref006","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1177\/1049732310392385","article-title":"Issues of expressed stigma of HIV\/AIDS among professionals in Southern Sudan","volume":"21","author":"EM Machine","year":"2011","journal-title":"Qual Health Res"},{"key":"pone.0354747.ref007","volume-title":"National HIV Testing and Counseling Report","author":"Ministry oHaCC","year":"2011"},{"key":"pone.0354747.ref008","volume-title":"Zimbabwe Demographic Health Survey","author":"ZimStat","year":"2011"},{"key":"pone.0354747.ref009","volume-title":"Zimbabwe National and Sub-National HIV Estimates Report 2017","author":"Ministry oHaCC","year":"2018"},{"key":"pone.0354747.ref010","volume-title":"AIDS, Religion and Women in Africa: Theo-Ethical Challenges and Imperatives. 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