Description
- Abstract:
- Background: Long-term patient engagement and retention in care has been an ongoing challenge within the HIV health system. Many patients who are thought to have disengaged are often categorized as "lost to follow-up" (LTFU) when in reality they may have sought care at another facility. Clinic switching may occur through formal channels of acquiring a transfer letter or informally by silently transferring. This study investigated the motivations that influence HIV-positive people to switch clinics, to understand the process of clinic switching, and to examine the components that influence a person to choose a new clinic. Methods: We conducted semi-structured, qualitative interviews in Gugulethu, South Africa with 19 people who are HIV positive and have switched clinics at least once since starting antiretroviral therapy (ART). Transcripts were analyzed using inductive and deductive thematic coding. Results: Among the 19 participants ten were female and nine were male and have had a HIV diagnoses on average for 14 years. 89.5% of the participants have switched clinics more than once with an average transferring four times. Participants often relayed their engagement experience in the context of a cycle using clinic switching as a tactic to regain entry into the health system. We identified five themes that relate to varying points in a patient’s cycle of engagement; 1) continued barriers to care, 2) internal and external stigma to be the “perfect patient” led patients to fully disengage, 3) pull factors back into care, 4) patients “tricks” and mechanisms to navigate re-entry into care and finally 5) continued motivation to stay engaged in care. Conclusion: These data illustrate multiple different time points within a patient cycle of engagement when focusing on long-term retention. Conventionally, HIV engagement has been conceptualized as a linear, unidirectional treatment cascade. Our study exposes the need to understand these cycles of engagement better in order to create interventions and clinic policies to help continued engagement of new, returning, and struggling patients.
- Notes:
- Thesis (M. P. H.)--Brown University, 2020
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- All rights reserved. Collection is open to the Brown community for research.
Citation
Beeman, Aly,
"“I am going to make tricks… whereby I am going to be a new person again”: Reimagining the framework for HIV care engagement from a cascade to a cycle model"
(2020).
Public Health Theses and Dissertations.
Brown Digital Repository. Brown University Library.
https://doi.org/10.26300/cfnm-kr69
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Public Health Theses and Dissertations
Theses and Dissertations for the Public Health department....