Online Program

Individual and structural factors affecting care linkage and engagement for HIV-positive individuals

Monday, November 4, 2013 : 2:45 p.m. - 3:00 p.m.

Amanda Tanner, PhD, MPH, Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC
Alice Ma, MPH, CHES, Public Health Education, University of North Carolina Greensboro, Greensboro, NC
Wendasha Jenkins, MS, University of North Carolina Greensboro, Greensboro, NC
Corliss Allen, MPH, Micromass Communications, Cary, NC
Ashley Young, MSPH, Rosedale Infectious Disease Clinic, Charlotte, NC
Crystal Piper, MPH, MHA, PhD, Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC
Background: To meet the National HIV/AIDS Strategy goal of rapid linkage to, and engagement in, care for HIV-infected individuals, a better understanding of the factors affecting this process is essential. Accordingly, the study's purpose was to identify multilevel factors affecting care behaviors.

Methods: Six focus groups were conducted with HIV-positive individuals in urban North Carolina (15 women, 16 men, and 2 male to female transgender individuals; age: 20-60, X=41; 17 parents). Data were managed using Atlas ti 6.2; content analysis examined factors related to care behaviors within a social-ecological framework.

Results: Data revealed individual and structural factors affecting HIV-related care. Individual factors included: age, gender, time since diagnosis, fertility desires/parental status, perceptions of respect from staff, and experiences with treatment side effects. Structural factors included: funding-related policies (e.g., insurance, Medicaid), access to transportation (“A lot of people lack [transportation access]…the bus here only comes like two or three times a day.”), and provider training (“A general practitioner is not going to be able to give you the same care that the likelihood of what Dr. C [infectious disease physician] can.”).

Discussion: Linkage to, and engagement in, care is critical for the long-term health of HIV-infected individuals and for reducing secondary transmission events. Addressing individual and structural issues specific to the individual's context and improving provider training may allow for increased engagement in care. Concentrating on the multilevel barriers to care is important as we develop and evaluate programs (e.g., test and treat) designed to meet the National HIV/AIDS Strategy goals.

Learning Areas:

Provision of health care to the public

Learning Objectives:
Describe factors affecting HIV-positive individuals’ care behaviors across the social-ecological model. Discuss implications for multilevel interventions for care engagement and viral load suppression. Identify ways in which health care providers, program staff, and policy makers can encourage and support care engagement for HIV-positive individuals.

Keyword(s): Access to Care, Access to Health Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting academic sexual and reproductive health (including HIV) research for the last 11 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.