title: "Getting me back on track": the role of outreach interventions in engaging and retaining people living with HIV/AIDS in medical care.
abstract: This qualitative study investigated the process of engagement in HIV medical care from the perspective of people living with HIV/AIDS (PLWHA). In-depth interviews were conducted with 76 participants in six cities. All participants were considered underserved because of histories of substance use, mental illness, incarceration, homelessness, or cultural barriers to the traditional health care system. A semistructured interview guide elicited narratives related to health care and the role of program interventions in facilitating access to care. Data analysis revealed that participants cycled in and out of care, a process that was influenced by (1) their level of acceptance of being diagnosed with HIV, (2) their ability to cope with substance use, mental illness, and stigma, (3) their health care provider relationships, (4) the presence of external support systems, and (5) their ability to overcome practical barriers to care. Outreach interventions played a role in connecting participants to care by dispelling myths and improving knowledge about HIV, facilitating access to HIV care and treatment, providing support, and reducing the barriers to care. The findings suggest that outreach programs can interrupt this cyclical process and foster sustained, regular HIV care for underserved PLWHA by conducting client-centered risk assessments to identify and reduce sources of instability and improve the quality of provider relationships; implementing strategies that promote healthy practices; creating a network of support services in the community; and supporting adherence through frequent follow-ups for medication and appointment keeping.
authors.affiliation: Health and Disability Working Group, Boston University School of Public Health, Boston, Massachusetts 02210, USA. rajabiun@bu.edu
authors.forename: Serena
authors.initials: S
authors.lastname: Rajabiun
authors.forename: R Kevin
authors.initials: RK
authors.lastname: Mallinson
authors.forename: Kate
authors.initials: K
authors.lastname: McCoy
authors.forename: Sharon
authors.initials: S
authors.lastname: Coleman
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.forename: Casey
authors.initials: C
authors.lastname: Rebholz
authors.forename: Tim
authors.initials: T
authors.lastname: Holbert
mesh_terms: D000293:Adolescent; D000328:Adult; D003159:Community-Institutional Relations; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D015397:Program Evaluation; D014481:United States; D014488:United States Health Resources and Services Administration / Q000458:organization & administration