Clinic-level complexities prevent effective engagement of people living with HIV who are out-of-care

被引:1
|
作者
Dutta, Srija [1 ]
Pulsifer, Brendan H. [2 ]
Dance, Kaylin V. [3 ]
Leue, Eric P. [4 ]
Beaupierre, Melissa [4 ]
Lowman, Kennedi [5 ]
Sales, Jessica M. [6 ]
Strahm, Melanie [4 ]
Sumitani, Jeri [4 ]
Colasanti, Jonathan A. [3 ]
Kalokhe, Ameeta S. [1 ,3 ]
机构
[1] Emory Univ, Rollins Sch Publ Hlth, Hubert Dept Global Hlth, Atlanta, GA 30329 USA
[2] Emory Sch Med, Atlanta, GA USA
[3] Emory Univ, Sch Med, Dept Med, Div Infect Dis, Atlanta, GA 30329 USA
[4] Grady Hlth Syst, Atlanta, GA USA
[5] THRIVESS Inc, Atlanta, GA USA
[6] Emory Univ, Rollins Sch Publ Hlth, Behav Social & Hlth Educ Sci, Atlanta, GA USA
来源
PLOS ONE | 2024年 / 19卷 / 05期
关键词
ANTIRETROVIRAL THERAPY; BARRIERS; FACILITATORS; RETENTION; ADHERENCE;
D O I
10.1371/journal.pone.0304493
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Approximately half of people living with HIV (PLWH) in the United States are not retained in HIV care. Although numerous studies have identified individual-level barriers to care (i.e., substance abuse, mental health, housing, transportation challenges), less is known about institutional-level barriers. We aimed to identify clinic-level barriers to HIV care and strategies to address them to better engage PLWH who have been out of care (PLWH-OOC). As part of a larger qualitative study in a Ryan White-funded HIV Clinic in Atlanta, which aimed to understand the acceptance and feasibility of community-based HIV care models to better reach PLWH-OOC, we explored barriers and facilitators of HIV care engagement. From October 2022-March 2023, 18 in-depth-interviews were conducted with HIV-care providers, administrators, social workers, and members of a Community Advisory Board (CAB) comprised of PLWH-OOC. Transcripts were coded by trained team members using a consensus approach. Several clinic-level barriers emerged: 1) the large burden placed on patients to provide proof of eligibility to receive Ryan White Program services, 2) inflexibility of provider clinic schedules, 3) inadequate processes to identify patients at risk of disengaging from care, 4) poorly-resourced hospital-to-clinic transitions, 5) inadequate systems to address primary care needs outside of HIV care, and 6) HIV stigma among medical professionals. Strategies to address these barriers included: 1) colocation of HIV and non-HIV services, 2) community-based care options that do not require patients to navigate complex transportation systems, 3) hospital and community-based peer navigation services, 4) dedicated staffing to identify and support PLWH-OOC, and 5) enhanced systems support to help patients collect the high burden of documentation required to receive subsidized HIV care. Several systems-level HIV care barriers exist and intersect with individual and community-level barriers to disproportionately affect HIV care engagement among PLWH-OOC. Findings suggest several strategies that should be considered to reach the remaining 50% of PLWH who remain out-of-care.
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页数:14
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