title: [Barriers to adherence and retention in public and private healthcare according to patients and health workers].
abstract: BACKGROUND
  The National Program of AIDS guarantees universal access to antiretroviral medication, yet people receiving treatment through the public healthcare system do not achieve an undetectable viral load in the same rate than patients in the private system. This qualitative study aims to identify factors associated with adherence and retention in the HIV-cascade of care at public and private setting from Buenos Aires, based on patients and healthcare workers' perceptions.
  
  
  METHODS
  Qualitative data from 12 semi-structured interviews with key informants and 4 focus groups of patients and healthcare workers from the public and private systems were recorded. Transcripts were coded and analyzed, using the QRS Nvivo9® software for qualitative data analysis, into set themes on adherence.
  
  
  RESULTS
  Patients and healthcare workers of both systems agree on the importance of HIV-related stigma, professional-patient relationship and communication, and the division of treatment-related responsibilities as fundamental aspects for adherence and retention in the HIV-cascade of care. Differences in the manner these factors interact were observed between healthcare systems. Structural barriers are presented as the main adherence barrier in the public system.
  
  
  CONCLUSIONS
  The need for interventions focused on the doctor-patient dyad considering the features of each healthcare is highlighted in order to facilitate patient engagement in adherence.
authors.affiliation: Fundación Huésped.
authors.forename: Inés
authors.initials: I
authors.lastname: Arístegui
authors.affiliation: Fundación Huésped.
authors.forename: Analía
authors.initials: A
authors.lastname: Dorigo
authors.affiliation: University of Miami Miller School of Medicine.
authors.forename: Lina
authors.initials: L
authors.lastname: Bofill
authors.affiliation: Helios Salud.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Bordatto
authors.affiliation: Fundación Huésped.
authors.forename: Mar
authors.initials: M
authors.lastname: Lucas
authors.affiliation: Helios Salud.
authors.forename: Graciela Fernández
authors.initials: GF
authors.lastname: Cabanillas
authors.affiliation: Fundación Huésped.
authors.forename: Omar
authors.initials: O
authors.lastname: Sued
authors.affiliation: Fundación Huésped.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cahn
authors.affiliation: Helios Salud.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cassetti
authors.affiliation: University of Miami Miller School of Medicine.
authors.forename: Stephen
authors.initials: S
authors.lastname: Weiss
authors.affiliation: University of Miami Miller School of Medicine.
authors.forename: Deborah
authors.initials: D
authors.lastname: Jones