title: Enroling and retaining human immunodeficiency virus (HIV) patients in their care: A metasynthesis of qualitative studies.
abstract: OBJECTIVE
  To report the findings of a metasynthesis review of qualitative studies on patient and provider experiences and perspectives on linkage and retention in HIV care.
  
  
  METHODS
  The review is an extraction, aggregation, interpretation and synthesis of qualitative findings based on the Sandelowski and Barroso method.
  
  
  METHODS
  A search of the literature was conducted in the databases Cumulative Index to Nursing and Allied Health, PubMed and PsycInfo for articles published from 2008 to 2013. Inclusion criteria were qualitative research articles published in English from across the world and in peer-reviewed journals. Literature reviews, conference abstracts and grey literature were excluded from this metasynthesis.
  
  
  METHODS
  The review consisted of a) comprehensive search, b) study classification, c) abstraction of findings, d) synthesis. Of the 4640 citations screened, 69 articles were included for this metasynthesis.
  
  
  RESULTS
  69 unique articles from 44 countries were included. This metasynthesis takes into account the perspectives of at least 2263 HIV-positive participants (740 men, 1008 women, 78 transgender individuals and 437 unspecified sex) and 994 healthcare providers, family members and community members. The most salient barriers and facilitators to HIV linkage and retention in HIV care affirm ecological factors that are mostly beyond individual patients' control. Triadic streams of influence concurrently affect care engagement that include a person's psychological state upon diagnosis and their informational challenges (intrapersonal stream); one-on-one interactions with providers and their immediate community (social stream); and life demands, overall quality of care experiences and other structural barriers (cultural-attitudinal stream). Each stream's influence on HIV care engagement varies at any given point to reflect an individual's evolving and unique experiences with HIV infection throughout the illness trajectory.
  
  
  CONCLUSIONS
  There is sufficient evidence that detail how to best link and retain patients in HIV care. Themes identified indicate going beyond individual-level factors and towards shifting attention and resources to systems that patients navigate. Forceful structural-level actions are needed to correct these long-identified barriers and enhance care engagement facilitators.
authors: Duke University School of Nursing, 307 Trent Drive, Durham NC 27710, United States. Electronic address: dalmacio@nursing.upenn.edu.
authors: Dalmacio
authors: D
authors: Flores
authors: University of Miami School of Nursing, United States.
authors: Natalie
authors: N
authors: Leblanc
authors: Medical University of South Carolina School of Nursing, United States.
authors: Julie
authors: J
authors: Barroso
mesh_terms: D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D036301:Qualitative Research
keywords: Acquired immune deficiency syndrome; HIV care continuum; HIV linkage and retention; Human immunodeficiency virus; Metasynthesis; Qualitative studies