How Providers Can Help Patients to Engage and Stay in the HIV Continuum of Care: A Socio-Medical Qualitative Approach

Background and Purpose:  Worldwide, the HIV Continuum of Care involves health promotion providers (e.g., social workers, health educators) linking at-risk individuals and HIV-infected patients to HIV testing, primary care, and antiretroviral treatments, services provided by trained medical personnel. Regrettably, linkages are not always made consistently and many patients end up not linked to or not retained in care. To design effective provider trainings that could improve this problem, we need to identify the key factors that influence providers’ linkage-making and thus how they help patients get into care and track them along the Continuum.

Methods: We used in-depth interview data from 20 providers randomly selected from a sample of 250 participants in a longitudinal study conducted in New York City (2012-2017) to examine the implementation of HIV prevention services with at risk populations.  We draw on a socio-medical perspective highlighting personal, interpersonal and environmental factors that influence how providers engage and retain patients in care. Interviews were transcribed verbatim and two independent researchers coded the data capturing factors occurring across all interviews, and which influenced how providers helped patients to engage and stay in care.  We combined a deductive and inductive approach to our analysis, guided by both the socioecological domains and our judgement as experienced practitioners.

Results: The sample included 14 females, six males. Ten providers identified as African American; seven White; two Asian; and one “more than one race.” Six providers identified as Latinos. The mean age was 43 years (range = 27-66). Data analysis revealed the following four main facilitators and/or barriers to linkage-making, each with an illustrative quote: 

1) Professional knowledge base and life changes, e.g. “I think by doing different trainings or webinars … bringing people together to talk about challenges…is helpful. Because you tend to only see things through your agency lens and have certain referrals or who you would go to“;

2) Providers’ interprofessional collaboration, e.g. “I know these places exist, but without building personal connections to those places, it always feels like a shot in the dark”;

3) Providers’ work-related changes, e.g. “When you take on extra duties that does affect how you collaborate because you have so much more to concentrate on instead of actually doing the collaboration. The client can suffer.”  

4) Best practices in a competitive environment, e.g. It’s a very competitive world, and a lot of agencies feel that if they collaborate they will lose their clients. “ 

Conclusions and Implications:  Each facilitator/barrier maps onto a socioecological domain, informing an explanatory model for how providers can more efficiently help patients to access HIV testing, primary care, and antiretroviral treatments. Findings provide the conceptual and empirical basis for developing and testing training interventions to help providers improve patients’ access/retention in care.  Our model is based on data from a demographically diverse workforce; therefore, findings may be applicable globally, particularly in areas with high HIV prevalence, such as sub-Saharan Africa. Our model may also be used to inform and optimize provider training on how to consistently and effectively link patients to care.