title: Barriers and Facilitators to Interventions Improving Retention in HIV Care: A Qualitative Evidence Meta-Synthesis.
abstract: Retention in HIV care is vital to the HIV care continuum. The current review aimed to synthesize qualitative research to identify facilitators and barriers to HIV retention in care interventions. A qualitative evidence meta-synthesis utilizing thematic analysis. Prospective review registration was made in PROSPERO and review procedures adhered to PRISMA guidelines. Nineteen databases were searched to identify qualitative research conducted with individuals living with HIV and their caregivers. Quality assessment was conducted using CASP and the certainty of the evidence was evaluated using CERQual. A total of 4419 citations were evaluated and 11 were included in the final meta-synthesis. Two studies were from high-income countries, 3 from middle-income countries, and 6 from low-income countries. A total of eight themes were identified as facilitators or barriers for retention in HIV care intervention: (1) Stigma and discrimination, (2) Fear of HIV status disclosure, (3) task shifting to lay health workers, (4) Human resource and institutional challenges, (5) Mobile Health (mHealth), (6) Family and friend support, (7) Intensive case management, and, (8) Relationships with caregivers. The current review suggests that task shifting interventions with lay health workers were feasible and acceptable. mHealth interventions and stigma reduction interventions appear to be promising interventions aimed at improving retention in HIV care. Future studies should focus on improving the evidence base for these interventions. Additional research is needed among women and adolescents who were under-represented in retention interventions.
authors: Global and Community Mental Health Research Group, Department of Psychology, University of Macau, E21-3040, Avenida da Universidade, Taipa, Macau (SAR), People's Republic of China. brianhall@umac.mo.|Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. brianhall@umac.mo.
authors: Brian J
authors: BJ
authors: Hall
authors: Global and Community Mental Health Research Group, Department of Psychology, University of Macau, E21-3040, Avenida da Universidade, Taipa, Macau (SAR), People's Republic of China.
authors: Ka-Lon
authors: KL
authors: Sou
authors: HIV/AIDS Department, World Health Organization, Geneva, Switzerland.
authors: Rachel
authors: R
authors: Beanland
authors: University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, People's Republic of China.
authors: Mellanye
authors: M
authors: Lacky
authors: University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, People's Republic of China.
authors: Lai Sze
authors: LS
authors: Tso
authors: University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, People's Republic of China.|Guangzhou Eighth People's Hospital, Guangzhou, People's Republic of China.
authors: Qingyan
authors: Q
authors: Ma
authors: HIV/AIDS Department, World Health Organization, Geneva, Switzerland.
authors: Meg
authors: M
authors: Doherty
authors: University of North Carolina Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095, People's Republic of China.
authors: Joseph D
authors: JD
authors: Tucker
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D004192:Discrimination, Psychological; D005239:Fear; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D057545:Social Stigma; D012944:Social Support; D017216:Telemedicine
keywords: ARV; Care continuum; HIV; Meta-synthesis; Retention