Abstract
Despite the existence of highly active antiretroviral therapy, HIV/AIDS morbidity and mortality continue to be public health burdens in the United States due to difficulties in engaging people living with HIV/AIDS (PLWHA) in continuous, effective care. In comparison to studies investigating patient-level characteristics associated with starting and remaining in care, there is relatively little research on how structural factors, such as those pertaining to healthcare providers and the infrastructure for delivery of health services, influence patients’ engagement in HIV care. Our study, based in the city of Baltimore, Maryland, uses qualitative research methods with a population of predominantly African American PLWHA who have a history of drug abuse, to examine facilitators and barriers regarding adherence to antiretroviral therapy (ART) and HIV care appointment attendance. Data collection involved conducting one-on-one, in-depth interviews with 31 study participants, and data analysis entailed thematic coding of interview transcripts and writing analytic memos to develop ideas and concepts. Among other findings, factors described as influential by our study participants related to appointment reminders and scheduling, the attitudes and communication styles of HIV clinicians, and the disposition and availability of other healthcare workers on the care “team.” Thus, improving quality of HIV care and means of delivering it may help mitigate the numerous points in the continuum of HIV care when a patient may disengage.
Highlights
In the United States, HIV/AIDS mortality is 2.2 per 100,000 residents [1]
We examined in detail both antiretroviral therapy (ART) adherence and clinic appointment attendance among a high-risk population of Baltimore City-based, predominantly African American people living with HIV/AIDS (PLWHA) who have a history of drug abuse
90% of the participants self-identified as non-Hispanic Black
Summary
In the United States, HIV/AIDS mortality is 2.2 per 100,000 residents [1]. In Baltimore City, Maryland, the rate is 21.1 per 100,000 residents [2]. Comparing the figures for different racial categories in Baltimore reveals a dramatic disparity: 6.3/100,000 in White non-Hispanics. Health Systems Factors Influencing Engagement in HIV Care: A Qualitative Study design, data collection and analysis, decision to publish, or preparation of this manuscript
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