title: A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions.
abstract: Retention in HIV medical care has been recognized as critical for long-term favorable clinical outcomes among HIV-positive patients. However, relatively little is known about specific factors related to HIV medical care adherence among HIV-positive women in rural areas in the United States, where the epidemic is rapidly growing among minorities and women. The objective of the current study was to assess barriers and facilitators to HIV clinic visit adherence among HIV-positive women in the rural southeastern region of the United States. Forty HIV-positive women were recruited from four outpatient clinics providing services to HIV-positive patients residing in 23 predominately rural counties in Alabama. Four focus groups were conducted ranging from 5 to 16 participants each. Content analysis was used to analyze and interpret the data. Data coding and sorting was conducted using QRS NVivo 8 software. Participants were predominately African American (92.3%) ranging in age from 29 to 69 years (mean = 46.1 years). On average, participants reported living with HIV for 8.8 years. Factors that impacted participants' ability to maintain clinic visit appointments included personal, contextual, and community/environmental factors that included: patient/provider relationships, family support, access to transportation, organizational infrastructure of the health care facility visited and perceived HIV stigma within their communities. The current study highlights the myriad of retention-in-care barriers faced by HIV-positive women living in rural areas in the southeastern United States. Innovative multilevel interventions that address these factors are sorely needed to increase long-term retention-in-care among HIV-positive women residing in rural areas.
authors.affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabam 35294-0022, USA. Mkempf@uab.edu
authors.forename: Mirjam-Colette
authors.initials: MC
authors.lastname: Kempf
authors.forename: Jen
authors.initials: J
authors.lastname: McLeod
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Boehme
authors.forename: Melonie W
authors.initials: MW
authors.lastname: Walcott
authors.forename: Laura
authors.initials: L
authors.lastname: Wright
authors.forename: Paula
authors.initials: P
authors.lastname: Seal
authors.forename: Wynne E
authors.initials: WE
authors.lastname: Norton
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Schumacher
authors.forename: Michael
authors.initials: M
authors.lastname: Mugavero
authors.forename: Linda
authors.initials: L
authors.lastname: Moneyham
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000407:Alabama / Q000453:epidemiology; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D006679:HIV Seropositivity; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009723:Nurse-Patient Relations; D010342:Patient Acceptance of Health Care; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012424:Rural Population; D011795:Surveys and Questionnaires