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

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.