142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

A New Model of the Decision Process to Link to HIV Care

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 9:15 AM - 9:30 AM

Christa Cook, PhD, MSN, RN , College of Nursing, University of Florida, Gainesville, FL
Barbara Lutz, PhD, RN, CRRN, APHN-BC, FNAP, FAAN , School of Nursing, College of Health and Human Services, University of North Carolina-Wilmington, Hampstead, NC

Linking people to HIV care improves individual and population outcomes, but many barriers to linkage exist. We sought to develop a model of the HIV care decision process and recommendations to improve linkage throughout the process in persons from smaller metropolitan and rural areas in Florida.


Using qualitative grounded theory methods, we interviewed 27 HIV-positive participants from North Central Florida, 25-64 years old. Participants were asked to describe the experience of diagnosis, the decision to link to care, and suggest recommendations at each point in the process. Results were analyzed using dimensional analysis with ongoing feedback from participants and community partners.


From the analysis, we identified conditions influencing the HIV care decision including: how someone defines care, active or passive linkage efforts, conflicting provider messages, and types and timing of support. After diagnosis, all participants described a crisis/grief response before deciding to seek care, and for those not seeking care, participants described pivotal life events that later led them to re-appraise the HIV care decision. At all points of the decision process, participants provided specific recommendations to promote linkage including: anticipatory guidance, navigation, peer support, counseling, holistic understanding, shared decisions, and emotional support.


From the constructs, relationships, and recommendations identified in the analysis, we were able to develop a linkage-to-care decision process model. The model identifies ways to bridge the gap between HIV prevention and care and can serve as a basis for future interventions to improve linkage in small metropolitan and rural populations.

Learning Areas:

Planning of health education strategies, interventions, and programs
Public health or related research
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the decision process for linking to HIV care for people in small metropolitan and rural areas of Florida. List recommendations provided by participant to promote linkage and retention in HIV care.

Keyword(s): HIV/AIDS, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working with community and state agencies and conducting research regarding linkage to HIV care for over 5 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.

Back to: 4043.0: Access to HIV/AIDS Care