title: "Taking a half day at a time:" patient perspectives and the HIV engagement in care continuum.
abstract: The HIV treatment continuum, or "cascade," outlines key benchmarks in the successful treatment of HIV-infected individuals. However, the cascade fails to capture important dimensions of the patient experience in that it has been constructed from a provider point of view. In order to understand meaningful steps in the HIV care cascade for individuals diagnosed with HIV through expanded, more routine testing, we conducted in-depth interviews (n=34) with three groups of individuals: those diagnosed with HIV in the emergency department/urgent care clinic who linked to HIV care and exhibited 100% appointment adherence in the first 6 months of HIV care; those diagnosed in the emergency department/urgent care clinic who linked to HIV care and exhibited sporadic appointment adherence in the first 6 months of HIV care, and; hospitalized patients with no outpatient HIV care for at least 6 months. This last group was chosen to supplement data from in-care patients. The engagement in care process was defined by a changing perspective on HIV, one's HIV identity, and the role of health care. The linkage to care experience laid the groundwork for subsequent retention. Interventions to support engagement in care should acknowledge that patient concerns change over time and focus on promoting shifts in perspective.
authors.affiliation: HIV/AIDS Division, San Francisco General Hospital, San Francisco, California 94110, USA. christopoulosk@php.ucsf.edu
authors.forename: Katerina A
authors.initials: KA
authors.lastname: Christopoulos
authors.forename: Amina D
authors.initials: AD
authors.lastname: Massey
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Lopez
authors.forename: Elvin H
authors.initials: EH
authors.lastname: Geng
authors.forename: Mallory O
authors.initials: MO
authors.lastname: Johnson
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Pilcher
authors.forename: Hegla
authors.initials: H
authors.lastname: Fielding
authors.forename: Carol
authors.initials: C
authors.lastname: Dawson-Rose
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000554:Ambulatory Care Facilities; D003266:Continuity of Patient Care; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011369:Professional-Patient Relations; D036301:Qualitative Research; D012495:San Francisco; D012944:Social Support; D013997:Time Factors
references.citation: AIDS Patient Care STDS. 2011 Sep;25(9):525-32
references.pmid: 21774689
references.citation: Soc Work Health Care. 2010;49(10):934-45
references.pmid: 21113849
references.citation: Clin Infect Dis. 2011 Jan 15;52 Suppl 2:S214-22
references.pmid: 21342910
references.citation: AIDS Patient Care STDS. 2007;21 Suppl 1:S40-8
references.pmid: 17563289
references.citation: Qual Health Res. 2007 Sep;17(7):919-31
references.pmid: 17724104
references.citation: Health Serv Res. 2000 Feb;34(6):1273-302
references.pmid: 10654830
references.citation: AIDS Patient Care STDS. 2012 Mar;26(3):165-72
references.pmid: 22248331
references.citation: Clin Infect Dis. 2012 Oct;55(8):1124-34
references.pmid: 22828593
references.citation: AIDS Patient Care STDS. 2007;21 Suppl 1:S3-8
references.pmid: 17563287
references.citation: AIDS Patient Care STDS. 2011 Jul;25(7):439-44
references.pmid: 21545296
references.citation: N Engl J Med. 2011 Aug 11;365(6):493-505
references.pmid: 21767103
references.citation: AIDS Patient Care STDS. 2012 Apr;26(4):214-21
references.pmid: 22320266
references.citation: AIDS Care. 2010 Dec;22(12):1493-8
references.pmid: 20824553
references.citation: Clin Infect Dis. 2009 Jan 15;48(2):248-56
references.pmid: 19072715
references.citation: Clin Infect Dis. 2011 Mar 15;52(6):793-800
references.pmid: 21367734
references.citation: AIDS Patient Care STDS. 2009 Jan;23(1):41-9
references.pmid: 19055408
references.citation: AIDS Care. 2007 Feb;19(2):195-202
references.pmid: 17364398
references.citation: AIDS Patient Care STDS. 2012 Jun;26(6):344-55
references.pmid: 22612447
references.citation: Acad Emerg Med. 2009 Feb;16(2):168-77
references.pmid: 19076107
references.citation: J Acquir Immune Defic Syndr. 2009 Jan 1;50(1):100-8
references.pmid: 19295340
references.citation: J Assoc Nurses AIDS Care. 2010 Nov-Dec;21(6):467-77
references.pmid: 20430653
references.citation: AIDS Patient Care STDS. 2007 Jun;21(6):418-25
references.pmid: 17594251
references.citation: Sociol Health Illn. 1982 Jul;4(2):167-82
references.pmid: 10260456
references.citation: Qual Health Res. 2009 Dec;19(12):1730-43
references.pmid: 19949222
references.citation: AIDS Patient Care STDS. 2009 Sep;23(9):785-92
references.pmid: 19645620
references.citation: AIDS Patient Care STDS. 2009 Sep;23(9):735-42
references.pmid: 19645619
references.citation: AIDS Care. 2012;24(6):737-43
references.pmid: 22148942
references.citation: AIDS Care. 2011 Oct;23(10):1219-25
references.pmid: 21562998
references.citation: AIDS Patient Care STDS. 2010 Aug;24(8):515-20
references.pmid: 20672971
references.citation: Clin Infect Dis. 2007 Jun 1;44(11):1493-9
references.pmid: 17479948
references.citation: J Acquir Immune Defic Syndr. 2012 May 1;60(1):77-82
references.pmid: 22267016