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

Background

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.

Methods

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.

Results

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.

Conclusions

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.