title: Facilitators and barriers in HIV linkage to care interventions: a qualitative evidence review.
abstract: To synthesize qualitative evidence on linkage to care interventions for people living with HIV.
  
  
  
  Systematic literature review.
  
  
  
  We searched 19 databases for studies reporting qualitative evidence on linkage interventions. Data extraction and thematic analysis were used to synthesize findings. Quality was assessed using the Critical Appraisal Skills Programme tool and certainty of evidence was evaluated using the Confidence in the Evidence from Reviews of Qualitative Research approach.
  
  
  
  Twenty-five studies from 11 countries focused on adults (24 studies), adolescents (eight studies), and pregnant women (four studies). Facilitators included community-level factors (i.e., task shifting, mobile outreach, integrated HIV, and primary services, supportive cessation programs for substance users, active referrals, and dedicated case management teams), and individual-level factors (encouragement of peers/family and positive interactions with healthcare providers in transitioning into care). One key barrier for people living with HIV was perceived inability of providers to ensure confidentiality as part of linkage to care interventions. Providers reported difficulties navigating procedures across disparate facilities and having limited resources for linkage to care interventions.
  
  
  
  Our findings extend the literature by highlighting the importance of task-shifting, mobile outreach, integrated HIV, and primary care services. Both community and individual-level factors may increase the feasibility and acceptability of HIV linkage to care interventions. These findings may inform policies to increase the reach of HIV services available in communities.
authors.affiliation: aUniversity of North Carolina Project-China, Guangzhou, ChinabInstitute for Global Health and Infectious Diseases at UNC-Chapel Hill, Chapel Hill, North Carolina, USAcGuangdong Provincial Center for STD Control, Guangzhou, ChinadSchool of Medicine, University of California, San Francisco, California, USAeHIV/AIDS Department World Health Organization, Geneva SwitzerlandfUniversity of Utah, Salt Lake City, Utah, USAgGuangzhou Eighth People's Hospital, Guangzhou, ChinahDepartment of Psychology, Global and Community Mental Health Research Group, University of Macau, Macau, ChinaiDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Lai Sze
authors.initials: LS
authors.lastname: Tso
authors.forename: John
authors.initials: J
authors.lastname: Best
authors.forename: Rachel
authors.initials: R
authors.lastname: Beanland
authors.forename: Meg
authors.initials: M
authors.lastname: Doherty
authors.forename: Mellanye
authors.initials: M
authors.lastname: Lackey
authors.forename: Qingyan
authors.initials: Q
authors.lastname: Ma
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Hall
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
mesh_terms: D001294:Attitude to Health; D001521:Behavior Therapy; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy*; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans