An Exploratory Study to Assess Individual and Structural Level Barriers Associated With Poor Retention and Re-engagement in Care Among Persons Living With HIV/AIDS

Abstract

Background Retention in care is the most challenging step along the HIV care continuum. Many patients who engage in care and achieve viral suppression have care interruptions, characterized by moving in and out of care (“churn”). Poor retention has clinical consequences and contributes to new HIV transmissions, but how to predict or prevent it remains elusive. This study sought to understand the relationship between individual- and structural-level barriers, and poor retention for persons living with HIV/AIDS in Atlanta, Georgia. Methods We administered a survey, through interviews, with HIV-infected patients continuously retained in care for 6 years (“continuously retained,” n = 32) and patients with recent gaps in care (“unretained” n = 27). We assessed individual-level protective factors for successful engagement (self-efficacy, resilience, perceived social support, and disclosure), risk factors for poor engagement (substance use, mental illness, and stigma), and structural/systemic-level barriers (financial and housing instability, transportation, food insecurity, communication barriers, incarceration history). Chi-square and Mann-Whitney U tests were used to compare the two populations. Results Both continuously retained and unretained populations had high rates of prior viral suppression but few unretained patients were virologically suppressed upon return to care (11%). Younger age, crack cocaine use, food insecurity, financial instability, housing instability and phone number changes in the past year were significantly more likely to be present in the unretained population. Conclusion Our findings suggest the need for targeted risk assessment tools to predict the highest risk patients for poor retention whereby public health interventions can be directed to those individuals.

Incidence rate, predictors and outcomes of interruption of HIV care: nationwide results from the Belgian HIV cohort

“…Younger patients were more vulnerable to HCI and to a gap in HIV care, in line with the findings of other studies [3,[20][21][22][23], but were less prone to permanent out-migration. It may be particularly challenging for young people to cope at once with the stigmatizing dimension of the disease, its impact on their sexual and emotional wellbeing and the necessary commitment to life-long medical care [20,24].…”

Resilience and HIV: a review of the definition and study of resilience

“…Another longitudinal study found that treatment self-efficacy also predicted medication adherence, visit adherence, CD4 cell count, and viral load (Turan et al, 2016). Three of the studies examined resilience resources that were associated with healthcare engagement and found that individual and interpersonal resources were critical to remaining engaged-in-care (Chen et al, 2013;Colasanti et al, 2017;Pecoraro et al, 2016).…”

“…Three articles examined resilience resources associated with healthcare engagement among PLWH. These studies suggested that PLWH who were engaged-incare had higher proactive coping (Pecoraro et al, 2016), greater HIV treatment adherence self-efficacy (Chen et al, 2013), social support (Colasanti, Stahl, Farber, del Rio, & Armstrong, 2017;Pecoraro et al, 2016), and more spirituality/religious beliefs (Pecoraro et al, 2016). However, Chen et al (2013) also found that PLWH with better healthcare provider engagement had lower self-esteem.…”

Promotion of Research on the HIV Continuum of Care in the United States: The CFAR HIV Continuum of Care/ECHPP Working Group

“…The authors conclude that early assessment for predictors of poor retention could help direct interventions to high risk patients. 54 …”