title: An in-depth mixed-methods approach to Ryan White HIV/AIDS care program comprehensive needs assessment from the Northeast Georgia Public Health District: the significance of patient privacy, psychological health, and social stigma to care.
abstract: We apply a social-ecological interpretive framework to understanding relationships among patient privacy, psychological health, social stigma, and continuity in care in the HIV treatment cascade in the rural southeastern US. This research was conducted as part of the 2013 comprehensive needs assessment for the Northeast Georgia Ryan White Consortium using an anthropologically informed mixed-methods design, and a deductive-inductive approach to thematic analysis of qualitative data obtained in interviews and focus groups with service providers and service utilizers. Our comprehensive needs assessment yielded two key components. First, we identified salient phenomena influencing introduction to, retention among, and satisfaction of patients in the Ryan White-coordinated treatment cascade in NE-GA. Second, we formulated actionable recommendations around leverage points identified in the current district-wide system of care. Results highlight spatial, institutional, and interpersonal aspects of the system of care that intersect around issues of patient privacy, psychological health, and social stigma. These intersections constitute pathways by which persons living with HIV are exposed to stigma and other negative social signals regarding their health status without sufficient access to behavioral health services. These negative issues, in turn, can erect significant barriers to long-term continuity in care.
authors.affiliation: The Institute of Development Studies, The University of Sussex, Brighton BN1 9RE, East Sussex, United Kingdom. Electronic address: a.huff@ids.ac.uk.
authors.forename: Amber
authors.initials: A
authors.lastname: Huff
authors.affiliation: Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall, Athens, GA 30602, USA. Electronic address: chumbler@uga.edu.
authors.forename: Neale
authors.initials: N
authors.lastname: Chumbler
authors.affiliation: Center for Global Health, College of Public Health, University of Georgia, Wright Hall Room 170, 100 Foster Road, Athens, GA 30602, USA. Electronic address: cobrien@uga.edu.
authors.forename: Colleen O'Brien
authors.initials: CO
authors.lastname: Cherry
authors.affiliation: Department of Health Promotion and Behavior, University of Georgia, 128 Wright Hall, Athens, GA 30602, USA. Electronic address: mirandaiverson@gmail.com.
authors.forename: Miranda
authors.initials: M
authors.lastname: Hill
authors.affiliation: Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall, Athens, GA 30602, USA. Electronic address: dhu3@uga.edu.
authors.forename: Vic
authors.initials: V
authors.lastname: Veguilla
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000523:psychology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003219:Confidentiality; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D005260:Female; D017144:Focus Groups; D005845:Georgia; D015658:HIV Infections / Q000523:psychology / Q000628:therapy*; D006297:Health Services Accessibility / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D016730:Program Development; D013240:Stereotyping; D055815:Young Adult
keywords: Barriers to care; HIV/AIDS; Leverage points; Mixed methods; Needs assessment; Patient privacy; Qualitative; Rural; Ryan White Programs; Stigma