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Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making.
AIDS Patient Care STDS. 2018 09; 32(9):368-378.AP

Abstract

Initial linkage to medical care is a critical step in the HIV care continuum leading to improved health outcomes, reduced morbidity and mortality, and decreased HIV transmission risk. We explored differences in perspectives on engagement in HIV care between people living with HIV who attended (Arrived) their initial medical provider visit (IMV) and those who did not (Missed), and between patients and providers. The study was conducted in two large majority/minority HIV treatment centers in the United States (US) south, a geographical region disproportionately impacted by HIV. The Theory of Planned Behavior informed semistructured interviews eliciting facilitators and barriers to engagement in care from 53 participants: 40 patients in a structured sample of 20 Missed and 20 Arrived, and 13 care providers. Using Grounded Theory to frame analysis, we found similar perspectives for all groups, including beliefs in the following: patients' control over care engagement, a lack of knowledge regarding HIV within the community, and the impact of structural barriers to HIV care such as paperwork, transportation, housing, and substance use treatment. Differences were noted by care engagement status. Missed described HIV-related discrimination, depression, and lack of social support. Arrived worried what others think about their HIV status. Providers focused on structural barriers and process, while patients focused on relational aspects of HIV care and personal connection with clinics. Participants proposed peer navigation and increased contact from clinics as interventions to reduce missed IMV. Context-appropriate interventions informed by these perspectives are needed to address the expanding southern HIV epidemic.

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Authors+Show Affiliations

Taylor BS
1 Department of Medicine, Division of Infectious Diseases, UT Health Science Center San Antonio , San Antonio, Texas.
Fornos L
2 Department of Research and Information Management, University Health System , San Antonio, Texas.
Tarbutton J
3 Department of Medicine, Division of Infectious Diseases, UT Southwestern Medical Center , Dallas, Texas.
Muñoz J
4 Round Rock Cancer Center , Baylor Scott & White Health, Round Rock, Texas.
Saber JA
5 HIV/STD Care Services Group , Texas Department of State Health Services, Austin, Texas.
Bullock D
1 Department of Medicine, Division of Infectious Diseases, UT Health Science Center San Antonio , San Antonio, Texas.
Villarreal R
2 Department of Research and Information Management, University Health System , San Antonio, Texas.
Nijhawan AE
3 Department of Medicine, Division of Infectious Diseases, UT Southwestern Medical Center , Dallas, Texas.

MeSH

AdolescentAdultAnti-HIV AgentsContinuity of Patient CareDecision MakingDelivery of Health CareFemaleFocus GroupsGrounded TheoryHIV InfectionsHealth BehaviorHealth Services AccessibilityHealthcare DisparitiesHumansInterviews as TopicMaleMiddle AgedPatient Acceptance of Health CareQualitative ResearchSocial StigmaSocial SupportSubstance-Related DisordersUnited States

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30179530

Citation

Taylor, Barbara S., et al. "Improving HIV Care Engagement in the South From the Patient and Provider Perspective: the Role of Stigma, Social Support, and Shared Decision-Making." AIDS Patient Care and STDs, vol. 32, no. 9, 2018, pp. 368-378.
Taylor BS, Fornos L, Tarbutton J, et al. Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making. AIDS Patient Care STDS. 2018;32(9):368-378.
Taylor, B. S., Fornos, L., Tarbutton, J., Muñoz, J., Saber, J. A., Bullock, D., Villarreal, R., & Nijhawan, A. E. (2018). Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making. AIDS Patient Care and STDs, 32(9), 368-378. https://doi.org/10.1089/apc.2018.0039
Taylor BS, et al. Improving HIV Care Engagement in the South From the Patient and Provider Perspective: the Role of Stigma, Social Support, and Shared Decision-Making. AIDS Patient Care STDS. 2018;32(9):368-378. PubMed PMID: 30179530.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making. AU - Taylor,Barbara S, AU - Fornos,Laura, AU - Tarbutton,Jesse, AU - Muñoz,Jana, AU - Saber,Julie A, AU - Bullock,Delia, AU - Villarreal,Roberto, AU - Nijhawan,Ank E, PY - 2018/9/5/entrez PY - 2018/9/5/pubmed PY - 2019/7/3/medline KW - HIV KW - care continuum KW - care engagement KW - qualitative research KW - social KW - stigma SP - 368 EP - 378 JF - AIDS patient care and STDs JO - AIDS Patient Care STDS VL - 32 IS - 9 N2 - Initial linkage to medical care is a critical step in the HIV care continuum leading to improved health outcomes, reduced morbidity and mortality, and decreased HIV transmission risk. We explored differences in perspectives on engagement in HIV care between people living with HIV who attended (Arrived) their initial medical provider visit (IMV) and those who did not (Missed), and between patients and providers. The study was conducted in two large majority/minority HIV treatment centers in the United States (US) south, a geographical region disproportionately impacted by HIV. The Theory of Planned Behavior informed semistructured interviews eliciting facilitators and barriers to engagement in care from 53 participants: 40 patients in a structured sample of 20 Missed and 20 Arrived, and 13 care providers. Using Grounded Theory to frame analysis, we found similar perspectives for all groups, including beliefs in the following: patients' control over care engagement, a lack of knowledge regarding HIV within the community, and the impact of structural barriers to HIV care such as paperwork, transportation, housing, and substance use treatment. Differences were noted by care engagement status. Missed described HIV-related discrimination, depression, and lack of social support. Arrived worried what others think about their HIV status. Providers focused on structural barriers and process, while patients focused on relational aspects of HIV care and personal connection with clinics. Participants proposed peer navigation and increased contact from clinics as interventions to reduce missed IMV. Context-appropriate interventions informed by these perspectives are needed to address the expanding southern HIV epidemic. SN - 1557-7449 UR - https://www.unboundmedicine.com/medline/citation/30179530/Improving_HIV_Care_Engagement_in_the_South_from_the_Patient_and_Provider_Perspective:_The_Role_of_Stigma_Social_Support_and_Shared_Decision_Making_ DB - PRIME DP - Unbound Medicine ER -