Facilitators and barriers to care initiation and continuity among persons living with HIV/AIDS in rural South Carolina: A qualitative study

Background: Established clinical guidelines and advances in antiretroviral therapies have significantly reduced morbidity and mortality among persons living with HIV/AIDS (PLWHA). Early initiation of care and continued engagement in care are vital for HIV treatment success at both the individual and population levels. However, a significant proportion of PLWHA fails to seek and remain in care after initial diagnosis. Identifying factors that influence patterns of utilization of HIV care among PLWHA is critical to developing strategies to increase initiation of and retention in care. This study identified personal, organizational, and environmental factors that facilitate or inhibit care initiation and care continuity among PLWHA living in a rural, predominantly minority county in South Carolina. Methods: The study employed focus group discussions with PLWHA and personal interviews with health care providers. Audio-recordings of the discussions and interviews were transcribed and analyzed to identify major themes. Results: Participating PLWHA identified several facilitators as well as multiple barriers to accessing and continuing care. Need for survival, self-determination, stigma, discrimination, disclosure, availability of infectious disease doctor, patient-provider interactions, transparency in provider actions and communication, and organizational culture/environment were some of the important themes that emerged from focus group discussions. Analysis of provider interviews yielded both similar and different themes, including the importance of a professional, trusting, and respectful care environment to facilitate access to care. Conclusion: Findings identify potential points of interventions to improve rates of initiation of and retention in care among PLWHA.