title: Barriers and facilitators to patient retention in HIV care.
abstract: BACKGROUND
  Retention in HIV care improves survival and reduces the risk of HIV transmission to others. Multiple quantitative studies have described demographic and clinical characteristics associated with retention in HIV care. However, qualitative studies are needed to better understand barriers and facilitators.
  
  
  METHODS
  Semi-structured interviews were conducted with 51 HIV-infected individuals, 25 who were retained in care and 26 not retained in care, from 3 urban clinics. Interview data were analyzed for themes using a modified grounded theory approach. Identified themes were compared between the two groups of interest: patients retained in care and those not retained in care.
  
  
  RESULTS
  Overall, participants identified 12 barriers and 5 facilitators to retention in HIV care. On average, retained individuals provided 3 barriers, while persons not retained in care provided 5 barriers. Both groups commonly discussed depression/mental illness, feeling sick, and competing life activities as barriers. In addition, individuals not retained in care commonly reported expensive and unreliable transportation, stigma, and insufficient insurance as barriers. On average, participants in both groups referenced 2 facilitators, including the presence of social support, patient-friendly clinic services (transportation, co-location of services, scheduling/reminders), and positive relationships with providers and clinic staff.
  
  
  CONCLUSIONS
  In our study, patients not retained in care faced more barriers, particularly social and structural barriers, than those retained in care. Developing care models where social and financial barriers are addressed, mental health and substance abuse treatment is integrated, and patient-friendly services are offered is important to keeping HIV-infected individuals engaged in care.
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. byehia@upenn.edu.|University of Pennsylvania Perelman School of Medicine, 1021 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA. byehia@upenn.edu.
authors.forename: Baligh R
authors.initials: BR
authors.lastname: Yehia
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Leslie.Stewart@uphs.upenn.edu.
authors.forename: Leslie
authors.initials: L
authors.lastname: Stewart
authors.affiliation: Department of Medicine, Drexel University School of Medicine, Philadelphia, PA, USA. momplaisirflorence@gmail.com.
authors.forename: Florence
authors.initials: F
authors.lastname: Momplaisir
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Aaloke.Mody@uphs.upenn.edu.
authors.forename: Aaloke
authors.initials: A
authors.lastname: Mody
authors.affiliation: Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, PA, USA. holtzmanc@icap.ls.org.
authors.forename: Carol W
authors.initials: CW
authors.lastname: Holtzman
authors.affiliation: Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Lisa.Jacobs@uphs.upenn.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Jacobs
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. Janet.Hines@uphs.upenn.edu.
authors.forename: Janet
authors.initials: J
authors.lastname: Hines
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. mounzerk@fight.org.|The Jonathan Lax Center, Philadelphia FIGHT, Philadelphia, PA, USA. mounzerk@fight.org.
authors.forename: Karam
authors.initials: K
authors.lastname: Mounzer
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. kglanz@upenn.edu.|Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA. kglanz@upenn.edu.
authors.forename: Karen
authors.initials: K
authors.lastname: Glanz
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. jmetlay@mgh.harvard.edu.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. sheaja@mail.med.upenn.edu.
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006296:Health Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D012944:Social Support; D055815:Young Adult