title: Barriers and Facilitators to Retaining and Reengaging HIV Clients in Care: A Case Study of North Carolina.
abstract: Retention in HIV care is critical to decrease disease-related mortality and morbidity and achieve national benchmarks. However, a myriad of barriers and facilitators impact retention in care; these can be understood within the social-ecological model. To elucidate the unique factors that impact consistent HIV care engagement, a qualitative case study was conducted in North Carolina to examine the barriers and facilitators to retain and reengage HIV clients in care. HIV professionals (n = 21) from a variety of health care settings across the state participated in interviews that were transcribed and analyzed for emergent themes. Respondents described barriers to care at all levels within the HIV prevention and care system including intrapersonal, interpersonal, institutional, community, and public policy. Participants also described recent statewide initiatives with the potential to improve care engagement. Results from this study may assist other states with similar challenges to identify needed programs and priorities to optimize client retention in HIV care.
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA miriam.berger@duke.edu.
authors.forename: Miriam B
authors.initials: MB
authors.lastname: Berger
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Kristen A
authors.initials: KA
authors.lastname: Sullivan
authors.affiliation: Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Parnell
authors.affiliation: Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Keller
authors.affiliation: North Carolina Community Health Center Association, Raleigh, NC, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Pollard
authors.affiliation: Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Cox
authors.affiliation: Communicable Disease Branch, North Carolina Department of Health and Human Services, Raleigh, NC, USA.
authors.forename: Jacquelyn M
authors.initials: JM
authors.lastname: Clymore
authors.affiliation: Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Center for AIDS Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Evelyn Byrd
authors.initials: EB
authors.lastname: Quinlivan
mesh_terms: D015658:HIV Infections; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D009657:North Carolina; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D012959:Socioeconomic Factors
keywords: HIV/AIDS; health providers; reengagement; retention; social–ecological model