A Qualitative Assessment of Retention in HIV Care Among Adolescents and Young Adults (AYA) Living with HIV in New York City

Overview

Journal AIDS Care

Publisher Informa Healthcare

Specialty Infectious Diseases

Date 2024 Jul 8

PMID 38976575

Authors

Eva Liang

Chigozie A Nkwonta

Lloyd A Goldsamt

Ann-Margaret Dunn Navarra

Affiliations

Soon will be listed here.

Abstract

Retention in HIV care is a critical precursor to ending the epidemic yet remains suboptimal in the United States. Gaining an understanding of the challenges faced by adolescents and young adults (AYA) living with HIV is essential to improving retention in HIV care. This study explored the barriers and facilitators to retention in care among Black and Hispanic AYA living with HIV. Audio-recorded semi-structured interviews were conducted with 20 AYA living with HIV ages 16-29 years in New York City. Our methods entailed an inductive content analysis to explore key concepts, reconcile codes, and identify a theme, categories, and subcategories. Bronfenbrenner's socioecological model evolved as an organizing framework around barriers and facilitators to retention in care at the individual, interpersonal, healthcare system, and structural level. Data analysis yielded one overarching theme-the influence of psychosocial factors on retention in HIV care. Psychological struggles, powerlessness, clinic-level characteristics, and socioeconomic struggles were barriers reported by participants. Self-responsibility, social support, patient-friendly healthcare services, and socioeconomic resources emerged as facilitators. Retention in HIV care among AYA living with HIV is a multifaceted and complex phenomenon that involves multiple systems. Strengthening patients, healthcare system, and community partnerships can help address some of the HIV-related health disparities.

Citing Articles

Associated Factors of Sexual Initiation among Male Vocational High School Students in Zhejiang Province, China: A Cross-sectional Study.

Zhao X, Yang Z, Wang H, Huang Y, Chen W Curr HIV Res. 2024; 22(4):270-277.

PMID: 39150029 DOI: 10.2174/011570162X321685240802072001.

References

Arnold E, Yalch M, Christodoulou J, Murphy D, Swendeman D, Rotheram-Borus M . Rumination influences the relationship between trauma and depression over time among youth living with HIV. J Affect Disord. 2022; 322:9-14. PMC: 9793436. DOI: 10.1016/j.jad.2022.11.010. View

Fernandez M, Harper G, Hightow-Weidman L, Kapogiannis B, Mayer K, Parsons J . Research Priorities to End the Adolescent HIV Epidemic in the United States: Viewpoint. JMIR Res Protoc. 2021; 10(1):e22279. PMC: 7813632. DOI: 10.2196/22279. View

Kahana S, Jenkins R, Bruce D, Fernandez M, Hightow-Weidman L, Bauermeister J . Structural Determinants of Antiretroviral Therapy Use, HIV Care Attendance, and Viral Suppression among Adolescents and Young Adults Living with HIV. PLoS One. 2016; 11(4):e0151106. PMC: 4817971. DOI: 10.1371/journal.pone.0151106. View

Dawson-Rose C, Cuca Y, Webel A, Solis Baez S, Holzemer W, Rivero-Mendez M . Building Trust and Relationships Between Patients and Providers: An Essential Complement to Health Literacy in HIV Care. J Assoc Nurses AIDS Care. 2016; 27(5):574-84. PMC: 5207494. DOI: 10.1016/j.jana.2016.03.001. View

Zanoni B, Mayer K . The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014; 28(3):128-35. PMC: 3948479. DOI: 10.1089/apc.2013.0345. View

Lall P, Lim S, Khairuddin N, Kamarulzaman A . Review: an urgent need for research on factors impacting adherence to and retention in care among HIV-positive youth and adolescents from key populations. J Int AIDS Soc. 2015; 18(2 Suppl 1):19393. PMC: 4344535. DOI: 10.7448/IAS.18.2.19393. View

Fisher J, Fisher W, Amico K, Harman J . An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006; 25(4):462-73. DOI: 10.1037/0278-6133.25.4.462. View

Beima-Sofie K, Begnel E, Golden M, Moore A, Ramchandani M, Dombrowski J . "It's Me as a Person, Not Me the Disease": Patient Perceptions of an HIV Care Model Designed to Engage Persons with Complex Needs. AIDS Patient Care STDS. 2020; 34(6):267-274. PMC: 7262637. DOI: 10.1089/apc.2019.0310. View

Fortenberry J, Koenig L, Kapogiannis B, Jeffries C, Ellen J, Wilson C . Implementation of an Integrated Approach to the National HIV/AIDS Strategy for Improving Human Immunodeficiency Virus Care for Youths. JAMA Pediatr. 2017; 171(7):687-693. DOI: 10.1001/jamapediatrics.2017.0454. View

10.

Ritchwood T, Malo V, Jones C, Metzger I, Atujuna M, Marcus R . Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review. BMC Public Health. 2020; 20(1):1195. PMC: 7398377. DOI: 10.1186/s12889-020-09312-1. View

11.

Mulawa M, Knippler E, Al-Mujtaba M, Wilkinson T, Ravi V, Ledbetter L . Interventions to Improve Adolescent HIV Care Outcomes. Curr HIV/AIDS Rep. 2023; 20(4):218-230. PMC: 10528099. DOI: 10.1007/s11904-023-00663-z. View

12.

Dunn Navarra A, Whittemore R, Bakken S, Rosenberg M, Gormley M, Bethea J . Adherence Self-Management and the Influence of Contextual Factors Among Emerging Adults With Human Immunodeficiency Virus. Nurs Res. 2020; 69(3):197-209. PMC: 7286659. DOI: 10.1097/NNR.0000000000000422. View

13.

Baim-Lance A, Angulo M, Chiasson M, Lekas H, Schenkel R, Villarreal J . Challenges and opportunities of telehealth digital equity to manage HIV and comorbidities for older persons living with HIV in New York State. BMC Health Serv Res. 2022; 22(1):609. PMC: 9073813. DOI: 10.1186/s12913-022-08010-5. View

14.

Hsieh H, Shannon S . Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9):1277-88. DOI: 10.1177/1049732305276687. View

15.

Dunn Navarra A, Rosenberg M, Gormley M, Bakken S, Fletcher J, Whittemore R . Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected.... AIDS Behav. 2022; 27(6):1807-1823. PMC: 9792943. DOI: 10.1007/s10461-022-03913-0. View

16.

Williams B, Amico K, Konkle-Parker D . Qualitative to assessment of barriers and facilitators to HIV treatment. J Assoc Nurses AIDS Care. 2011; 22(4):307-12. PMC: 3117967. DOI: 10.1016/j.jana.2010.11.001. View

17.

Sprague C, Simon S . Understanding HIV care delays in the US South and the role of the social-level in HIV care engagement/retention: a qualitative study. Int J Equity Health. 2014; 13:28. PMC: 3983673. DOI: 10.1186/1475-9276-13-28. View

18.

Hendricks L, Eshun-Wilson I, Rohwer A . A mega-aggregation framework synthesis of the barriers and facilitators to linkage, adherence to ART and retention in care among people living with HIV. Syst Rev. 2021; 10(1):54. PMC: 7875685. DOI: 10.1186/s13643-021-01582-z. View

19.

Hao J, Long D, Relyea Ashley H, Budhwani H, Simpson T, Hill S . The Characteristics of Youth With Missed HIV Visits in Alabama. Open Forum Infect Dis. 2024; 11(3):ofae086. PMC: 10911224. DOI: 10.1093/ofid/ofae086. View

20.

Sangaramoorthy T, Haddix M, Agopian A, Yellin H, Mouhanna F, Abdi H . Measuring Unmet Needs among Persons Living with HIV at Different Stages of the Care Continuum. AIDS Behav. 2021; 25(6):1954-1967. PMC: 8085070. DOI: 10.1007/s10461-020-03125-4. View