title: Nonengagement in HIV care: a descriptive and qualitative study in hospitalized patients and community-based analysis.
abstract: Nonengagement in HIV care is a major clinical and public health challenge. To identify the risk factors and reasons, we performed (1) a retrospective study of patients admitted to the hospital with advanced HIV disease, (2) a prospective qualitative study, and (3) a population-based area-wide telephone interview. In the retrospective study, clinic care engagement was associated with age (43.9 ± 9.1 years vs 37.9 ± 7.2 years, P = .005) and improved from 23% to 44% (P = .03) after hospitalization. Survival was higher (93% vs 73%, P = .03) among those who engaged in care. Twelve inpatients were interviewed in the qualitative study. Themes identified for nonengagement were social stigma, indifference, or lack of understanding of care needs/denial and life care issues. In the population-based study, 145 patients were interviewed. In all, 49 denied the need for HIV care and 28 denied their HIV status. Stigma, denial, and indifference or lack of understanding of need are significant barriers to care engagement.
authors: Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA.
authors: Kavitha C
authors: KC
authors: Rao
authors: Maithe
authors: M
authors: Enriquez
authors: Tynisha C
authors: TC
authors: Gantt
authors: Mary M
authors: MM
authors: Gerkovich
authors: Aaron J
authors: AJ
authors: Bonham
authors: Ron G
authors: RG
authors: Griffin
authors: David M
authors: DM
authors: Bamberger
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000523:psychology* / Q000628:therapy*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010358:Patient Participation; D011446:Prospective Studies; D036301:Qualitative Research; D012189:Retrospective Studies; D057545:Social Stigma; D012959:Socioeconomic Factors
keywords: HIV; community; nonengagement in care; qualitative