Breastfeeding support experiences of mothers of preterm infants in China: a qualitative study.

Ensuring continuous access to antiretroviral therapy (ART) is critical to achieving the global 95-95-95 HIV targets []. To improve treatment adherence and reduce barriers to care, India’s National AIDS Control Programme (NACP) has prioritized differentiated service delivery models (DSDMs), including multi-month dispensing, same-day ART initiation, and decentralized ART refills []. Despite these strategies, missing ART clinic appointments and loss to follow-up persist, often driven by long travel distances, transportation costs, waiting times, and fear of stigma [–]. Person-centered care through the decentralization of ART services to peripheral health facilities has been instrumental in bringing services closer to people living with HIV (PLHIV) and reducing the travel and financial burden of accessing care. However, proximity alone may not fully determine service preference. Prior studies indicate that PLHIV deliberately seeks ART services outside their residential catchment area to reduce the risk of being recognized and to prevent unintended HIV-status disclosure within their community [, ] reflecting stigma-avoidance and confidentiality concerns []. While decentralized services closer to one’s residence may reduce structural barriers [], this option may simultaneously heighten concerns related to perceived or anticipated stigma, particularly in smaller or close-knit communities [, ]. In this regard, decentralization can create a strain between convenience and privacy, as services closer to home may increase concerns about confidentiality and stigma; addressing this trade-off is central to person-centered HIV care [, ]. Andhra Pradesh (AP), a southern Indian state with an adult HIV prevalence of 0.62% []. Although ART services are widely available in peripheral health facilities, many PLHIV continue to travel long distances from their residence to tertiary or secondary hospitals. India’s National HIV treatment guidelines are in alignment with the global guidelines [] in recommending decentralized ART services in the sub-district peripheral hospitals as a part of person-centered care for stable PLHIV []. Majority of decentralized facilities lack the capacity to manage complications, increasing the risk of morbidity, mortality, and drug resistance if care is fragmented.