title: Patient-provider perceptions on engagement in HIV care in Argentina.
abstract: Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients' lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient-provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.
authors.affiliation: a Department of Psychiatry and Behavioral Sciences , University of Miami, Miller School of Medicine , Miami , FL , USA.
authors.forename: Lina Margarita
authors.initials: LM
authors.lastname: Bofill
authors.forename: Maria
authors.initials: M
authors.lastname: Lopez
authors.forename: Analia
authors.initials: A
authors.lastname: Dorigo
authors.forename: Alejandra
authors.initials: A
authors.lastname: Bordato
authors.forename: Mar
authors.initials: M
authors.lastname: Lucas
authors.forename: Graciela Fernandez
authors.initials: GF
authors.lastname: Cabanillas
authors.forename: Omar
authors.initials: O
authors.lastname: Sued
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.forename: Isabel
authors.initials: I
authors.lastname: Cassetti
authors.forename: Stephen
authors.initials: S
authors.lastname: Weiss
authors.forename: Deborah
authors.initials: D
authors.lastname: Jones
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001118:Argentina; D003142:Communication; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D008297:Male; D009313:National Health Programs; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D036301:Qualitative Research; D020377:Self Efficacy; D012938:Social Perception; D057545:Social Stigma; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology*; D035502:Trust; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents