Objectives

To assess reasons for patients being lost-to-care (LTC) at an urban health center (Philadelphia, PA, USA) that provides access to oral tenofovir/emtricitabine(TDF/FTC) as pre- exposure prophylaxis(PrEP) to patients ages 13-30 years through a drop-in model of care.

Methods

Ninety-nine patients were identified as LTC based on not visiting a clinician in ≥4 months during the period April 2016-January 2017. Patients were contacted by phone/email to participate in a voluntary telephone survey regarding reasons for falling out of care. Results were analyzed descriptively.

Results

Of the 99 patients preliminarily identified as LTC, 19 completed the survey. Reason(s) for becoming LTC included: 47%(9) relocation, 11%(2) transportation difficulties to/from clinic, 26%(5) financial/insurance problems, 5%(1) perceived medication side effects, 16%(3) trouble remembering to attend appointments regularly, 5%(1) difficulty with daily medication adherence, and 0% social stigma. Furthermore, 21%(4) remain at high-risk of HIV/STI acquisition after becoming LTC. The main study limitations are selection bias and small sample size, where the small sample size did not allow for statistical significance.

Conclusion

While the major cause for becoming LTC was relocation, these findings suggest 37% of LTC incidences may be preventable with additional/up-front support. Because 21% of LTC patients remain at high-risk of HIV/STI acquisition, proactive re-engagement initiatives are potentially useful.

Keywords

HIV/AIDS; Pre-exposure prophylaxis; Retention and care; Socioeconomic factors; Adolescent Health; Lesbian/Gay/Bisexual/Transgender Persons.

Aims/Objectives

Despite previous findings attesting to the syndemic nature of human immunodeficiency virus (HIV), chronic disease and mental illness coordination of these issues remains a significant barrier to initiating and maintaining the delivery of mental and physical health care to persons living with HIV (PLWH). These inequities are even greater when applied to rural settings, particularly in areas that are medically underserved. To date, there is scarce research regarding the lived experiences of African American PLWH
in rural settings. Constructivist grounded theory was used to analyze this qualitative data set. These discourses provide a rich narrative regarding effective systems of care, the context in which these processes take place and related constraints or limitations of the current systems.

Methods

In-depth interviews with 24 African American PLWH both inside (N=20) and outside (N=4) of care in rural Northwestern Virginia were conducted. Rural African American PLWH were queried about their perceptions of the provision of HIV health care services, barriers to linkages to care, retention of PLWH in care, and recommendations for improving HIV health care services for rural PLWH.

Results

Participants offered insights on the linkages to health and mental health care consistent with the pattern recommended by the cascade of care (i.e. pre-screening, testing, refer to treatment, treatment and sustain treatment). Participants identified contextual factors, including traumatic events, medication (side effects), other chronic health issues, issues with the current health and mental health system, stigma, and lack of social support. We highlight PLWH’s recommendations for linking rural PLWH into care and sustaining that care.

Conclusion

We discuss the implications of these findings for programmatic development in the rural context.

Keywords

Rural African Americans living with HIV; Barriers to HIV health care; Rural South; HIV lived experience.