HIV Care Providers' Perceptions of Treatment Retention Barriers atthe Atlanta Veterans Administration Medical Center Open Access

Williams, Amanda Elise (2016)

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The HIV care continuum is a framework for depicting the stages of HIV treatment. Examining HIV treatment in various contexts using this framework can highlight how a particular healthcare system is functioning in regards to HIV treatment. At the Atlanta Veterans Administration Medical Center (AVAMC), retention in HIV care has the most drastic decline in proportion, despite relatively high proportions along all steps in the continuum when compared to national averages. This study aims to examine providers' perceptions of the barriers to retention in care at the AVAMC in an effort to understand causes of retention failures according to providers who have particular insight on clinic barriers. Qualitative in-depth interviews were conducted with a range of HIV care providers at the AVAMC. Results identified three perceptions held by providers about patients that vary based on whether patients are in- or out-of-care. These included views on patient psycho-social stability, motivation for treatment, and patient frustrations. These perceptions were carried throughout providers' views of retention barriers, which were categorized into three distinct groups through thematic analysis. Clinic barriers included lack of resources, scheduling, rotating providers, and wait time; the barriers within this category were largely associated with patient experiences at the clinic and the patient-provider relationship. Socioeconomic barriers included patient social network, transportation, homelessness, and financial circumstance/job status, which are not wholly addressed through veteran resources and services. Health barriers included mental health issues and substance abuse, which were associated with patients' compliance to care recommendations. Understanding providers' perceptions of patients and the barriers to treatment retention garners valuable insight into barriers particularly related to the clinic due their knowledge and experience as employees.

Table of Contents

Chapter I: Introduction

Introduction and Rationale

Problem Statement

Study Purpose

Primary Research Question

Significance Statement

Chapter II: Extended Literature Review

The HIV Care Continuum in the U.S.

The HIV Care Continuum at the VA

Barriers to HIV Treatment Retention in the U.S.

Examining HIV Barriers within the Veteran Population

HIV Barriers at the AVAMC

Patient-Provider Relationships

Patient Satisfaction

Barriers to Positive Patient-Provider Relationships

Theories of Patient-Provider Relationships

A Conceptual Framework for Patient-Provider Communication

Providers' Perspectives

Chapter 3: Manuscript







Chapter 4: Public Health Implications

Public Health Context

Public Health Limitation

Study Limitations



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