Clinical Influences on Patient Retention in HIV Treatment at VA Medical Center Open Access

Abstract

Social determinants of health create significant disparities in disease burden and access to health care in the United States. Within the HIV-infected population, clear disparities in HIV infection and retention in HIV treatment exist in the United States based around these social determinants. Among the population of veterans in the United States, disparities in HIV diagnosis, care, and outcomes are as severe or more severe as in the overall population. However, differences in demographics and the unique structure of the VA health system can lead to differences in veterans' access to HIV care. In the following project, we examine how the HIV positive patient's experience of healthcare at the Atlanta Veterans Affairs Medical Center (AVAMC) influences their retention in HIV treatment. We used secondary analysis of qualitative data to determine the barriers that inhibited retention for participants with an external locus of control and identify the attitudes that facilitated retention for participants with an internal locus of control. Results identified three central interrelated elements of the clinic experience that influences retention in care. For the external locus of control group, clinic waiting time, their level of confidence in clinicians, and customer service acted as barriers to retention within the clinical setting. For the internal locus of control group, patience with structural issues, level of confidence in clinicians, and interpersonal connections facilitated higher rates of retention in HIV treatment. The findings of this study provide the foundation for further research to design clinic interventions to improve clinic-based barriers to retention in treatment for HIV positive patients in the AVAMC.

Table of Contents

CHAPTER I. INTRODUCTION. 2

Context of Project. 2

Problem Statement. 3

Purpose of Project. 4

CHAPTER II. REVIEW OF RELEVANT LITERATURE. 4

Social Determinants of Health. 5

HIV/AIDS-Related Health Disparities. 8

Veterans' Health. 11

HIV Care Frameworks. 15

Human Health Behavior Theories. 16

Interventions Along the Continuum of Care. 26

Patient Experience. 30

Conclusions. 31

CHAPTER III. MANUSCRIPT. 33

Abstract. 36

Introduction. 37

Methods. 40

Results. 43

Discusion. 49

Conclusions. 52

References. 53

Figures. 56

CHAPTER IV. DISCUSSION AND PUBLIC HEALTH IMPLICATIONS. 57

Public Health Context. 57

Public Health Implications. 58

REFERENCES. 64

APPENDIX. 77

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Qualitative Retention Continuum of Care Atlanta Secondary Analysis Patient Experience Grounded Theory Locus of Control Patient Provider Veterans Affairs HIV/AIDS Wait Time AVAMC
Committee Chair / Thesis Advisor	Hennink, Monique, Emory University
Committee Members	Marconi, Vincent, Emory University

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