Abstract
Competing needs pose barriers to engagement in HIV medical care. Mixed methods were used to explore and describe the needs of participants enrolled in Access to Care, a national HIV linkage, retention and re-engagement in care (LRC) program that served people living with HIV who knew their status but were not engaged in care. When asked to prioritize their most urgent needs, participants reported housing or shelter (31%), HIV medical services (24%), and employment (8%). When we assessed the HIV continuum of care by needs status, we found no significant differences in linkage, retention, or viral suppression between participants with and without basic needs. Qualitative interviews with program staff contextualized the barriers to HIV medical care faced by participants and explored the strategies used by LRC programs to address participant needs. Study findings will be of use to future programs and have implications for HIV policy, in particular the implementation of the National HIV/AIDS Strategy (2015–2020).
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Acknowledgements
The authors would like to express their gratitude to the A2C intervention staff for their dedication and for the individuals who participated in the A2C intervention. We would like to thank Dr. Russell Brewer for his insightful contributions to the discussion section. This document is based upon work under Grant No. 10SIHDC001 and supported by the Social Innovation Fund (SIF), a program of the Corporation for National and Community Service (CNCS). Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, CNCS or the Social Innovation Fund program. The Social Innovation Fund is a program of the Corporation for National and Community Service, a federal agency that engages millions of Americans in service through its AmeriCorps, Senior Corps, Social Innovation Fund, and Volunteer Generation Fund programs, and leads the President’s national call to service initiative, United We Serve. For more information, visit NationalService.gov. Opinions or points of view expressed in this document are those of the authors and do not necessarily reflect the official position of, or a position that is endorsed by, the Corporation or the Social Innovation Fund, AIDS United, Johns Hopkins Bloomberg School of Public Health, or the grantees of the A2C initiative. We would also like to acknowledge those whose who took time to review the manuscript and thank Dr. Ronald Valdiserri for his invaluable contributions.
Funding
This study was funded by AIDS United in partnership with the Social Innovations Fund, a program of the Corporation for National and Community Service (CNCS) Fund (Grant No. 10SIHDC001).
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Catherine Maulsby, Blessing Enobun, D. Scott Batey, Kriti Jain, The Access to Care Intervention Team, Maura Riordan, Melissa Werner, and David Holtgrave have no conflicts of interest to disclose.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Program sites underwent IRB approval locally. Program evaluation activities implemented by ActionWellness (Chesapeake IRB) and The Damien Center (IntegReview) were found to be non-human subjects research and to not require IRB oversight. Program evaluation activities conducted by the University of Alabama at Birmingham (University of Alabama) and Louisiana Public Health Institute (Ethical and Independent Review Services) were found to be human subjects research and informed consent was obtained from participants. JHU’s IRB found the qualitative portion of this study to be non-human subjects research and informed consent was not obtained for individuals interviewed about organizational-level programmatic activities.
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The members of the A2C Evaluation Intervention Team: Elizabeth Hagan, Cody Poerio, Dorsche Pinsky, Odessa Summers (Action Wellness, Philadelphia, PA) Michael Hassler (COMHAR, Philadelphia, PA), Dagmar Mitchell (Together House and Gaudenzia, Philadelphia, PA), Hal Shanis, (Shanis Analysis, Philadelphia, PA) James Peightel (Pathways to Housing, Philadelphia, PA); Sarah Chrestman and Russell Brewer (Louisiana Public Health Institute, New Orleans, LA); David Fine, Charles Shumate, and Sara Salomon (CARDEA Services, Seattle, WA), Abbe Shapiro (The Damien Center, Indianapolis, IA); D. Scott Batey (University of Alabama at Birmingham, Birmingham, AL).
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Maulsby, C., Enobun, B., Batey, D.S. et al. A Mixed-Methods Exploration of the Needs of People Living with HIV (PLWH) Enrolled in Access to Care, a National HIV Linkage, Retention and Re-Engagement in Medical Care Program. AIDS Behav 22, 819–828 (2018). https://doi.org/10.1007/s10461-017-1809-3
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DOI: https://doi.org/10.1007/s10461-017-1809-3