title: Provider-Level and Other Health Systems Factors Influencing Engagement in HIV Care: A Qualitative Study of a Vulnerable Population.
abstract: Despite the existence of highly active antiretroviral therapy, HIV/AIDS morbidity and mortality continue to be public health burdens in the United States due to difficulties in engaging people living with HIV/AIDS (PLWHA) in continuous, effective care. In comparison to studies investigating patient-level characteristics associated with starting and remaining in care, there is relatively little research on how structural factors, such as those pertaining to healthcare providers and the infrastructure for delivery of health services, influence patients' engagement in HIV care. Our study, based in the city of Baltimore, Maryland, uses qualitative research methods with a population of predominantly African American PLWHA who have a history of drug abuse, to examine facilitators and barriers regarding adherence to antiretroviral therapy (ART) and HIV care appointment attendance. Data collection involved conducting one-on-one, in-depth interviews with 31 study participants, and data analysis entailed thematic coding of interview transcripts and writing analytic memos to develop ideas and concepts. Among other findings, factors described as influential by our study participants related to appointment reminders and scheduling, the attitudes and communication styles of HIV clinicians, and the disposition and availability of other healthcare workers on the care "team." Thus, improving quality of HIV care and means of delivering it may help mitigate the numerous points in the continuum of HIV care when a patient may disengage.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Yukyan
authors.initials: Y
authors.lastname: Lam
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America.
authors.forename: Ryan
authors.initials: R
authors.lastname: Westergaard
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Gregory
authors.initials: G
authors.lastname: Kirk
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Azal
authors.initials: A
authors.lastname: Ahmadi
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Genz
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Keruly
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Heidi
authors.initials: H
authors.lastname: Hutton
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015142:Baltimore / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006296:Health Services; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D019966:Substance-Related Disorders / Q000150:complications; D035862:Vulnerable Populations
chemical_list: D019380:Anti-HIV Agents