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Publication Profiles

Clinic-level complexities prevent effective engagement of people living with HIV who are out-of-care

Citation

Dutta S, Pulsifer BH, Dance KV, et al. Clinic-level complexities prevent effective engagement of people living with HIV who are out-of-care. PLoS One. 2024;19(5):e0304493. doi:10.1371/journal.pone.0304493

Implementation stage:

Pre-Implementation

Implementation outcomes reported:

Not applicable

Continuum target addressed:

Engagement in treatment (including retention and re-engagement)

Geography:

Fulton County-GA

Study Participant Classification:

Providers, Community member(s)

Plain Language Objectives

The researchers interviewed clinic staff, administrators, social workers, and community advisers with lived experience of being out of HIV care. They wanted to understand clinic processes that drive disengagement and identify practical ways to bring people back into care.

Plain Language Abstract

Many people with HIV are not consistently retained in care, and clinic systems can compound housing, transportation, mental health, and other individual barriers. Researchers conducted 18 in-depth interviews at a Ryan White-funded Atlanta clinic between October 2022 and March 2023. Participants included providers, administrators, social workers, and community advisory board members with experience being out of care. They identified burdensome eligibility documentation, inflexible schedules, weak systems for recognizing patients at risk of disengagement, poorly supported hospital-to-clinic transitions, limited access to primary care outside HIV services, and stigma among medical professionals. Suggested strategies included colocating HIV and other care, providing community-based options, adding hospital and community peer navigation, dedicating staff to identify and support disengaged patients, and helping patients assemble required documents. These qualitative findings show how clinic and broader barriers can intersect. The study identified options for a future model but did not implement them or show that they improve retention. Results from one clinic may not apply to every setting.

Key Takeaways

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