Understanding Barriers and Facilitators Experienced by HIV Care Providers When Engaging and Retaining Patients in Care: Results from a Qualitative Study Jamie Hart, PhD, MPH 1 ; Cynthia Klein, PhD 2 ; Alejandra Mijares, MPH 2 ; Theresa Spitzer, PhD c 1 ; Clarke Erickson, MHA 1 ; James W. Carey, PhD, MPH 3 ; Monique Carry, PhD 3 ; Deborah Gelaude, MPH 3 ; Nicole Pitts, BS 4 ; and Damian Denson, PhD, MPH 3 1 Atlas Research, 2 Abt Associates, 3 U.S. Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, 4 ICF International PROVIDER DEMOGRAPHICS RESULTS: FACILITATORS TO ENGAGEMENT AND RETENTION RESULTS: BARRIERS TO ENGAGEMENT AND RETENTION PRACTICAL IMPLICATIONS OF RESPONDENT STRATEGIES TO FACILITATE ENGAGEMENT AND RETENTION IN CARE The following implications were derived from the analysis process and identification of common/prominent themes within the data. Treat the “Whole Patient”  Ensure that HIV care providers and facilities include ‘whole patient’ needs.  Build capacity of healthcare facilities to be a “one stop shop” for the full spectrum of HIV care (e.g., co-located services, plus active referral and linkage to external health and social services).  Increase the involvement of pharmacists. Enhance the Flexibility of Providers and Clinic Procedures  Conduct additional research to better understand the impact of insurance- and medication-related policies on engagement in HIV care.  Train primary care providers to manage patients who are virally suppressed to supplement the work of HIV specialist providers.  Strengthen monitoring and evaluation of care engagement within facilities (including identification and follow-up with patients who fall out of care). Improve Patient/Provider Relationships and Communication  Obtain and include patient perspectives on what they need to successfully be engaged in HIV care (e.g., culturally competent communication and creation of a sense of shared responsibility and decision making).  Specific needs may: o Vary between individual patients. o Vary between patient subgroups. o Evolve over time for a patient, patient subgroup, facility, or community. o Require diversity among and training for staff at all levels. Address Stigma and Misconception of HIV as a Disease  Ensure that care facilities feel welcoming and non-stigmatizing to patients.  Help patients develop skills for handling stigma outside of the facility. Identify and Share Lessons Learned  Identify effective and useful promising practices.  Facilitate opportunities to share successful care engagement strategies between different providers and facilities. Atlanta, GABaltimore, MDWashington, DCTotal years years years More than 55 years 2 (20%) 3 (30%) 2 (20%) 4 (40%) 2 (20%) 1 (10%) 3 (30%) 3 (33%) 1 (11.1%) 4 (44.4%) 1 (11.1%) 9 (31%) 6 (20.7%) 8 (27.6%) 6 (20.7%) Hispanic or Latino/a Non-Hispanic or Latino/a - 10 (100%) - 10 (100%) 6 (60%) 4 (40%) 6 (20%) 24 (80%) Asian Black/African American White - 3 (30%) 7 (70%) 1 (10%) 2 (20%) 7 (70%) - 9 (90%) 1 (3.4%) 5 (17.2%) 23 (79.3%) Female Male 5 (50%) 8 (80%) 2 (20%) 6 (60%) 4 (40%) 19 (63.3%) 11 (36.7%) Homosexual, gay/lesbian Heterosexual or straight Bisexual 2 (20%) 8 (80%) - 2 (22.2%) 5 (55.6%) 2 (22.2%) 3 (33.3%) 5 (55.6%) 1 (11.1%) 7 (25%) 18 (64.3%) 3 (10.7%) StrategyExample quotes reflecting common/prominent themes within the data Availability of a Broad Range of Providers In a Single Location “The amount of resources we have in terms of nursing support, having social workers onsite, having dieticians onsite, having a specific nurse educator onsite, having a peer educator onsite. Having all of that here keeps the patient from having to try and corral all of these resources from multiple organizations. We can actually have access to a lot of those things here and you have an advocate for you that’s in your doctor’s office.” – Physician, Atlanta Offering Supportive Services “[Patients] don’t have to qualify for our services even if they’ve lost their insurance. They can still come see us [the social workers] and we don’t just kick them to the curb. It’s “how can we help you stay engaged in care? How can we get you insurance again?” There are some times with some people where it’s just not financially realistic for them to stay in a private practice…and we’re very instrumental in helping them connect to another practice.” –Case Manager, Atlanta Flexibility of Clinic Procedures and Providers to Meet Unique Needs of Patients “This is the only place they want to go when they leave their house. We have their medications delivered here and the pharmacist helps distribute them to them and makes sure it’s organized….I think that is why people come [here] because they can walk in and they know all of us. A lot of people call us their family.” – Nurse Practitioner, Washington StrategyExample quotes reflecting common/prominent themes within the data Logistical Financial, and Capacity-based Barriers to Connecting Patients to Needed Services “Frankly, with the system as it is now I feel overwhelmed trying to finish four patients in a half day. By the time you address substance abuse, mental health, safe sex the list goes on and not to mention their asthma or any other health issue. We end up doing a lot of primary care, which I love as a primary care physician, but it’s exhausting.” – Physician, Atlanta Issues Related to Insurance Coverage “There has always been the pushback from insurers about what is covered, whether it is laboratory tests or even medications. [You decide] to start this patient on meds, this patient wants to start, but insurers put up this road block.” – Physician, Atlanta Continuing Stigma and Misconception of HIV as a Disease “Somebody doesn’t want to take the medication because somebody lives in their house and they don’t want it to be found so they refuse medication. They refuse treatment. Somebody can’t get support because they can’t tell their family because of the stigma.” – Nurse Practitioner, Washington BACKGROUND/METHODOLOGY Problem: It is estimated that 60% of PLWH in the US are not receiving consistent HIV care due to delayed diagnosis, inadequate linkage to care, and barriers to retention to HIV care. Purpose: To collect qualitative data from 30 HIV care providers in three major metropolitan areas regarding perceived barriers and facilitators to engaging patients in HIV care. Rationale: While small in scope, this study:  Has important implications in the ongoing efforts to improve the HIV continuum of care.  Supports the role and importance of HIV care providers in effectively reducing the gap in continuous and consistent HIV care. Analysis:  Interviews were recorded, transcribed, and coded by patterns and themes.  Analysis was conducted using NVivo® 10 qualitative data analysis software.  Descriptive statistics of demographic data were performed using SPSS® statistical software.