HIV Care Disengagement and Antiretroviral Treatment Discontinuation in Mexico: A Qualitative Study Based on the Ecological Model Among Men Who Have Sex With Men

Aguilera-Mijares, Santiago; Martínez-Dávalos, Araczy; Vermandere, Heleen; Bautista‐Arredondo, Sergio

doi:10.1097/jnc.0000000000000332

Cited by 2 publications

(3 citation statements)

References 22 publications

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“…No studies included children. While all studies included people with experience of disengagement from ART, four studies included only participants who had subsequently re‐engaged with care [15, 17, 21, 32], and seven included a mixture of people who had re‐engaged after a period of disengagement and those who remained disengaged [14, 24, 26–28, 30, 31]. Twenty were single‐country studies with 16 in Africa, three in the Americas and one in Europe.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 21 studies, three were conference abstracts [12][13][14] and the remainder were full papers (Table 1). Six studies were about general adult populations [12,[14][15][16][17][18], nine were about women who started ART while pregnant [19][20][21][22][23][24][25][26][27] and six were about various smaller populations (people who use drugs [13], indigenous people in an isolated area [28], adolescents [29], gay/bisexual/other men who have sex with men [30], men only [31] and women only [32]). No studies included children.…”

Section: R E S U Lt Smentioning

confidence: 99%

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Reasons for disengagement from antiretroviral care in the era of “Treat All” in low‐ or middle‐income countries: a systematic review

Burke,

Rickman,

Pinto

et al. 2024

J Int AIDS Soc.

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IntroductionDisengagement from antiretroviral therapy (ART) care is an important reason why people living with HIV do not achieve viral load suppression become unwell.MethodsWe searched two databases and conference abstracts from January 2015 to December 2022 for studies which reported reasons for disengagement from ART care. We included quantitative (mainly surveys) and qualitative (in‐depth interviews or focus groups) studies conducted after “treat all” or “Option B+” policy adoption. We used an inductive approach to categorize reasons: we report how often reasons were reported in studies and developed a conceptual framework for reasons.ResultsWe identified 21 studies which reported reasons for disengaging from ART care in the “Treat All” era, mostly in African countries: six studies in the general population of persons living with HIV, nine in pregnant or postpartum women and six in selected populations (one each in people who use drugs, isolated indigenous communities, men, women, adolescents and men who have sex with men). Reasons reported were: side effects or other antiretroviral tablet issues (15 studies); lack of perceived benefit of ART (13 studies); psychological, mental health or drug use (13 studies); concerns about stigma or confidentiality (14 studies); lack of social or family support (12 studies); socio‐economic reasons (16 studies); health facility‐related reasons (11 studies); and acute proximal events such as unexpected mobility (12 studies). The most common reasons for disengagement were unexpected events, socio‐economic reasons, ART side effects or lack of perceived benefit of ART. Conceptually, studies described underlying vulnerability factors (individual, interpersonal, structural and healthcare) but that often unexpected proximal events (e.g. unanticipated mobility) acted as the trigger for disengagement to occur.DiscussionPeople disengage from ART care for individual, interpersonal, structural and healthcare reasons, and these reasons overlap and interact with each other. While HIV programmes cannot predict and address all events that may lead to disengagement, an approach that recognizes that such shocks will happen could help.ConclusionsHealth services should focus on ways to encourage clients to engage with care by making ART services welcoming, person‐centred and more flexible alongside offering adherence interventions, such as counselling and peer support.

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Section: Resultsmentioning

confidence: 99%

Section: R E S U Lt Smentioning

confidence: 99%

Reasons for disengagement from antiretroviral care in the era of “Treat All” in low‐ or middle‐income countries: a systematic review

Burke,

Rickman,

Pinto

et al. 2024

J Int AIDS Soc.

View full text Add to dashboard Cite

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“…Numerous studies have shown that patients who experienced and anticipated stigma are less willing to disclose their HIV status to others for fear of rejection and exclusion, which motivates them to avoid the social situation (Parker and Aggleton, 2003;Hedge et al, 2021;Ndione et al, 2022). Meanwhile, previous studies have confirmed that a high level of social support was linked with optimal self-management behaviors (Aguilera-Mijares et al, 2022). For example, Du et al (2018) indicated that a better social support MSM living with HIV obtained was associated with higher condom use intentions.…”

Section: Mediating Effect Of Social Supportmentioning

confidence: 99%

The relationship between HIV-related stigma and HIV self-management among men who have sex with men: The chain mediating role of social support and self-efficacy

Yan

Xiao

et al. 2022

Front. Psychol.

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HIV infection becomes a manageable disease, and self-management is one of the key indicators of achieving optimal health outcomes. Men who have sex with men (MSM) living with HIV face many psychosocial challenges when managing HIV infection, such as sexual minority pressure and HIV-related stigma. Higher perceived HIV-related stigma had been related to low self-management. However, the mechanisms underlying the association between HIV-related stigma and HIV self-management are unclear. Two possible mediators include social support and self-efficacy. This study aimed to examine the relationship between HIV-related stigma and HIV self-management among MSM living with HIV and to explore the single mediating effect of social support and self-efficacy and the chain mediating effect of these two variables on this relationship in China. Convenience sampling was used to recruit participants from the Center for Disease Control (CDC) in Changsha City, Hunan province, China. A total of 459 MSM living with HIV completed questionnaires regarding sociodemographic and disease-related information, HIV-related stigma, social support, self-efficacy, and HIV self-management. Descriptive statistics analysis, one-way ANOVA, independent t-tests, Pearson’s bivariate correlation, and multiple regression were conducted using the SPSS v24.0. Process macro in SPSS was used to analyze the single and chain mediating effect among variables. Our findings showed that the indirect and total effect of HIV-related stigma on HIV self-management was significant, while the direct effect was not statistically significant. Social support and self-efficacy mediated the relationship between HIV-related stigma and HIV self-management, respectively. Moreover, the chain mediating model confirmed that the association between HIV-related stigma and HIV self-management was mediated by social support and self-efficacy sequentially. Future interventions focusing on improving HIV self-management among MSM living with HIV should consider a multi-faced approach.

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HIV Care Disengagement and Antiretroviral Treatment Discontinuation in Mexico: A Qualitative Study Based on the Ecological Model Among Men Who Have Sex With Men

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 2 publications

References 22 publications

Reasons for disengagement from antiretroviral care in the era of “Treat All” in low‐ or middle‐income countries: a systematic review

Reasons for disengagement from antiretroviral care in the era of “Treat All” in low‐ or middle‐income countries: a systematic review

The relationship between HIV-related stigma and HIV self-management among men who have sex with men: The chain mediating role of social support and self-efficacy

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