title: Factors contributing to dropping out from and returning to HIV treatment in an inner city primary care HIV clinic in the United States.
abstract: Although advances in pharmacotherapy have enabled people living with HIV/AIDS to live longer, fuller lives, some leave medical care, resulting in sub-optimal treatment and increased health risk to themselves and others. Forty-one patients who dropped out of an urban, publically funded primary care HIV clinic were contacted and encouraged by outreach staff to return. Participants were interviewed within two weeks of returning, and themes associated with dropping out and returning were elicited and content analyzed. Dropping out was associated with drug/alcohol use, unstable housing/homelessness, psychiatric disorders, incarceration, problems with HIV medications, inability to accept the diagnosis, relocation, stigma, problems with the clinic, and forgetfulness. Returning was associated with health concerns, substance abuse treatment/recovery, stable housing, incarceration/release, positive feelings about the clinic, spirituality, and assistance from family/relocation. Because a large number of patients reported substance abuse, depression, and past suicide attempts. Clinic staff should assess substance use, depression, and suicidal ideation at each primary care visit and encourage patients to obtain substance abuse treatment and mental health care. Future interventions could include providing SBIRT and/or onsite mental health and substance abuse treatment, all of which may boost retention.
authors: a Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
authors: Anna
authors: A
authors: Pecoraro
authors: Charlotte
authors: C
authors: Royer-Malvestuto
authors: Beth
authors: B
authors: Rosenwasser
authors: Kevin
authors: K
authors: Moore
authors: Allen
authors: A
authors: Howell
authors: Michelle
authors: M
authors: Ma
authors: George E
authors: GE
authors: Woody
mesh_terms: D000328:Adult; D005069:Evaluation Studies as Topic; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D016903:Drug Monitoring