title: A Framework to Inform Strategies to Improve the HIV Care Continuum in Low- and Middle-Income Countries.
abstract: Reasons for attrition along the HIV care continuum are well described. However, improving patient engagement in care has been a challenge. New approaches to understanding and responding to reasons for attrition are required. Here, with a focus on low- and middle-income countries, we propose a framework that brings together an explanatory model with social ecological levels. Individual action may be based on a conscious or unconscious balance between perceived value and perceived costs. When the balance between value and cost favors value, engagement in care can be expected. Value and cost may be mediated by levels of the individual, interpersonal interactions, the clinic experience, community, society, and policy. We encourage the use of a framework for developing strategies to improve the care continuum and believe that this framework provides a rigorous approach.
authors.affiliation: Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, Maryland.|Aurum Institute, Johannesburg, South Africa.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hoffmann
authors.affiliation: Aurum Institute, Johannesburg, South Africa.
authors.forename: Tonderai
authors.initials: T
authors.lastname: Mabuto
authors.affiliation: Aurum Institute, Johannesburg, South Africa.
authors.forename: Kerrigan
authors.initials: K
authors.lastname: McCarthy
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health.
authors.forename: Catherine
authors.initials: C
authors.lastname: Maulsby
authors.affiliation: Johns Hopkins University Bloomberg School of Public Health.
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
mesh_terms: D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D003266:Continuity of Patient Care / Q000191:economics / Q000706:statistics & numerical data; D003906:Developing Countries; D015658:HIV Infections / Q000523:psychology / Q000628:therapy*; D006679:HIV Seropositivity / Q000188:drug therapy / Q000191:economics; D005102:Health Expenditures; D006801:Humans; D010352:Patient Dropouts / Q000523:psychology; D012931:Social Environment
chemical_list: D019380:Anti-HIV Agents