title: Lost-to-care and engaged-in-care HIV patients in Leningrad Oblast, Russian Federation: barriers and facilitators to medical visit retention.
abstract: Sixty-nine percent of the 1.5 million Eastern Europeans and Central Asians with HIV live in the Russian Federation. Antiretroviral therapy (ART) is effective but cannot help those who leave treatment. Focus groups with patients who dropped out of ART for ≥12 months (lost-to-care, LTCs, n = 21) or continued for ≥12 months (engaged-in-care; EICs; n = 24) were conducted in St. Petersburg. Structural barriers included stigma/discrimination and problems with providers and accessing treatment. Individual barriers included employment and caring for dependents, inaccurate beliefs about ART (LTC only), side-effects, substance use (LTCs, present; EICs, past), and depression. Desire to live, social support, and spirituality were facilitators for both; EICs also identified positive thinking and experiences with ART and healthcare/professionals. Interventions to facilitate retention and adherence are discussed.
authors.affiliation: a Department of Psychiatry, Perelman School of Medicine , University of Pennsylvania , Philadelphia , PA , USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Pecoraro
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.forename: Elena
authors.initials: E
authors.lastname: Verbitskaya
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.forename: Sergii
authors.initials: S
authors.lastname: Dvoriak
authors.forename: George
authors.initials: G
authors.lastname: Woody
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000600:supply & distribution / Q000627:therapeutic use*; D003863:Depression; D004651:Employment; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010352:Patient Dropouts / Q000523:psychology* / Q000706:statistics & numerical data; D011287:Prejudice; D011369:Professional-Patient Relations; D012426:Russia / Q000453:epidemiology; D057545:Social Stigma; D012944:Social Support; D029181:Spirituality; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: AIDS; HIV; Russian Federation; attrition; positive psychology; retention