title: Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen's Behavioral Model.
abstract: Andersen's Behavioral Model (ABM) provides a framework for understanding how patient and environmental factors impact health behaviors and outcomes. We compared patient-identified barriers/facilitators to retention in care and antiretroviral therapy (ART) adherence and evaluated how they mapped to ABM. Qualitative semi-structured interviews with 51 HIV-infected adults at HIV clinics in Philadelphia, PA, in 2013 were used to explore patients' experiences with HIV care and treatment. Interview data were analyzed for themes using a grounded theory approach. Among those interviewed, 53% were male and 88% were nonwhite; 49% were retained in care, 96% were on ART, and 57% were virally suppressed. Patients discussed 18 barriers/facilitators to retention in care and ART adherence: 11 common to both behaviors (stigma, mental illness, substance abuse, social support, reminder strategies, housing, insurance, symptoms, competing life activities, colocation of services, provider factors), 3 distinct to retention (transportation, clinic experiences, appointment scheduling), and 4 distinct to adherence (medication characteristics, pharmacy services, health literacy, health beliefs). Identified barriers/facilitators mapped to all ABM domains. These data support the use of ABM as a framework for classifying factors influencing HIV-specific health behaviors and have the potential to inform the design of interventions to improve retention in care and ART adherence.
authors: a Department of Pharmacy Practice , Temple University School of Pharmacy , Philadelphia , PA , USA.
authors: Carol W
authors: CW
authors: Holtzman
authors: Judy A
authors: JA
authors: Shea
authors: Karen
authors: K
authors: Glanz
authors: Lisa M
authors: LM
authors: Jacobs
authors: Robert
authors: R
authors: Gross
authors: Janet
authors: J
authors: Hines
authors: Karam
authors: K
authors: Mounzer
authors: Rafik
authors: R
authors: Samuel
authors: Joshua P
authors: JP
authors: Metlay
authors: Baligh R
authors: BR
authors: Yehia
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology*; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D015143:Philadelphia; D017410:Practice Guidelines as Topic; D036301:Qualitative Research; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Andersen's Behavioral Model; adherence; antiretroviral therapy; barriers; retention in care