Key Stakeholder Perceptions of a Mobile HIV Care Model to Re-engage and Retain Out-of-care People Living with HIV in Atlanta, Georgia Open Access

Henkhaus, Michelle (Spring 2020)

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Background: To reach national targets, novel strategies to re-engage and retain people living with HIV (PLWH) who are out of care are greatly needed. While mobile clinics have been used effectively for HIV testing and linkage, their use in providing HIV care is limited in the published literature. To guide the development of a mobile HIV clinic (MHC) model as a strategy to re-engage and retain PLWH who are out of care, we aimed to first explore key stakeholder perceptions and preferences for MHC implementation.

Methods: From June 2019-December 2019, as part of a larger mixed-methods study, 36 in-depth interviews were conducted with HIV clinic providers, staff, legal authorities, administrators, and Community Advisory Board members, AIDS service organizations, organizations implementing mobile health care, and city officials in Atlanta. Thematic analysis was used to examine perceived advantages, barriers, and facilitators of successful MHC implementation.

Results: Many supported use of MHCs if a few critical barriers were addressed (i.e. potential breach of confidentiality with resulting stigma, fractured continuity of care, safety concerns, staffing challenges, and community acceptance), and noted advantages (i.e. convenience, patient-centered care, potential to improve provider/staff understanding of patients’ environments and display their commitment, and greater community reach). Participants provided suggestions (i.e. appropriate exterior design, MHC location and timing, and co-delivery of non-HIV services) that would facilitate MHC implementation and address key concerns.

Conclusions: MHCs have potential to be acceptable, effective means of re-engaging and retaining PLWH who are out of care. By identifying barriers and strategies to overcome them, this study informs the design of future MHCs and enables further research to test their effectiveness in improving re-engagement and retention among PLWH who are out of care.

Table of Contents

Chapter One: Introduction. 1

Chapter Two: Comprehensive Literature Review.. 5

Retention in the HIV Treatment Cascade. 5

Retention goals and implications. 5

State of Retention in the southern United States and Georgia. 6

People Living with HIV in Atlanta, Georgia. 7

Current Strategies for Retention in HIV Care. 8

Barriers to retention. 8

Current strategies and effectiveness of these strategies. 9

Mobile Health Clinics. 11

What are they?. 11

Acceptability, feasibility, effectiveness, and current use of mobile health clinics. 12

Mobile health clinics used for HIV testing, counseling, and linkage to care. 14

Mobile health clinics used for HIV treatment 16

Mobile health clinics in in Atlanta, Georgia. 22

Summary of Current Literature and Gaps. 23

Chapter Three: Manuscript 26

Contribution of Student 27

Abstract 28

Introduction. 29

Methods. 32

Results. 39

Discussion. 63

Conclusions. 72

Chapter Four: Public Health Implications. 74

References. 75

Appendices. 79

Appendix A: Interview Guides and Visual Aids. 79

Appendix B: Study Protocol 96

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