Provider-Level and Other Health Systems Factors Influencing Engagement in HIV Care: A Qualitative Study of a Vulnerable Population

• Published in: PloS one Vol. 11; no. 7; p. e0158759
• Main Authors: Lam, Yukyan, Westergaard, Ryan, Kirk, Gregory, Ahmadi, Azal, Genz, Andrew, Keruly, Jeanne, Hutton, Heidi, Surkan, Pamela J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 18.07.2016; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Baltimore - epidemiology; Biology and Life Sciences; Care and treatment; Data analysis; Data collection; Data processing; Delivery scheduling; Drug abuse; Drug therapy; Female; Health care; Health Services; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV patients; Human immunodeficiency virus; Humans; Infections; Intervention; Male; Maryland - epidemiology; Medical care; Medical diagnosis; Medical personnel; Medicine; Medicine and Health Sciences; Middle Aged; Morbidity; Mortality; Occupational health; Patient Acceptance of Health Care; Patient satisfaction; People and Places; Population studies; Practice; Public health; Qualitative Research; Quality management; Research and Analysis Methods; Research methods; Substance-Related Disorders - complications; Systematic review; Therapy; United States; Vulnerable Populations; Workers; United States; United States > US; Maryland; Baltimore Maryland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0158759

Despite the existence of highly active antiretroviral therapy, HIV/AIDS morbidity and mortality continue to be public health burdens in the United States due to difficulties in engaging people living with HIV/AIDS (PLWHA) in continuous, effective care. In comparison to studies investigating patient-level characteristics associated with starting and remaining in care, there is relatively little research on how structural factors, such as those pertaining to healthcare providers and the infrastructure for delivery of health services, influence patients' engagement in HIV care. Our study, based in the city of Baltimore, Maryland, uses qualitative research methods with a population of predominantly African American PLWHA who have a history of drug abuse, to examine facilitators and barriers regarding adherence to antiretroviral therapy (ART) and HIV care appointment attendance. Data collection involved conducting one-on-one, in-depth interviews with 31 study participants, and data analysis entailed thematic coding of interview transcripts and writing analytic memos to develop ideas and concepts. Among other findings, factors described as influential by our study participants related to appointment reminders and scheduling, the attitudes and communication styles of HIV clinicians, and the disposition and availability of other healthcare workers on the care "team." Thus, improving quality of HIV care and means of delivering it may help mitigate the numerous points in the continuum of HIV care when a patient may disengage.