Patient–provider perceptions on engagement in HIV care in Argentina

Abstract

Approximately 30% of patients participating in the national antiretroviral therapy (ART) program in Argentina fail to achieve an undetectable viral load, and approximately 25% are not retained in care. This qualitative study was designed to explore and identify factors associated with engagement and retention in public and private health care in Buenos Aires, Argentina. Qualitative data from key informants (n = 12) and focus groups (n = 4 groups) of patients and providers from private and public HIV treatment facilities were recorded and transcribed. Predetermined and arising themes related to adherence, engagement, and retention in care were coded and analyzed using qualitative data analysis software. Reasons identified for patients’ lack of adherence or engagement in care differed between patients and providers, and patients attributed limitations to low self-efficacy, fear and concerns about HIV, and lack of provider involvement in treatment. In contrast, providers viewed themselves as decision-makers in patient care and patients as responsible for their own nonadherence due to lack of commitment to their own health or due to medication side effects. Patients reported health care system limitations and HIV concerns contributed to a lack of engagement, and providers identified limited HIV literacy and stigma as additional problems. Both agreed that chronic illness and substance addiction impacted adherence and retention, and agreed on the importance of trust, honesty, and communication in the patient–provider relationship. Results support the incorporation of system-, provider-, and patient-focused components into interventions to facilitate patient engagement, adherence, and retention in public and private settings in Argentina.

Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa

“…Further, our participants reported that their trauma experiences made it difficult for them to develop trusting relationships, which has the potential to adversely impact HIV care engagement (40). Studies conducted with HIV patients in multiple settings have found that the level of trust in the patient-provider relationship is a strong predictor of ART adherence and HIV care engagement outcomes, and future research should explore these relationships in low-resource settings (41-43). …”

Associação entre percepção de doença e ansiedade, depressão e autoeficácia em pessoas com HIV/Aids

“…Pesquisas indicam que pessoas com elevada autoefi cácia são mais propensas a apresentar uma adesão ao tratamento satisfatória (Bofi ll et al, 2014;Houston et al, 2015;Seidl et al, 2007). No presente estudo esta variável correlacionou-se com percepção de doença, especialmente com percepção de controle pessoal (crença do indivíduo na capacidade de controlar a doença) e controle do tratamento (crença na efi cácia do tratamento), associação também descrita em um estudo multicêntrico.…”

Patient and Provider Perspectives on HIV and HIV-Related Stigma in Dutch Health Care Settings

“…[38][39][40] Research on the impact of HIV-related stigma in health care has shown that perceived stigmatization in health care settings is related to decreased patient satisfaction, psychological distress, low self-esteem, the feeling that one is undeserving of care, and diminished motivation to stay healthy, 14,31,41 while positive interactions between health care providers and PLWH have been found to contribute to better treatment adherence and health-related quality of life. [42][43][44][45] Clearly, ensuring that PLWH feel accepted and treated equally in health care settings is imperative. This is particularly important as PLWH's reliance on health care providers and need for adequate health care services will, in the coming years, continue to grow as a result of aging demographics among PLWH.…”