What factors influence engagement in HIV care? A qualitative investigation

A Howarth1 , F Burns1 , S Michie1 , C Sabin1 , V Apea2 , R O’Connell2 , A Evans3 and M Sachikonye4 1 UCL, London, UK; 2 Barts Health NHS Trust, London, UK; 3 Royal Free Hospital, London, UK; 4 UK-CAB, London, UK

Background: The individual and public health benefits of HIV treatment can only be realised when people living with HIV (PLWH) are aware of their status and engaged in care. Patient engagement is a major challenge with little evidence available on the factors that need to be addressed. We investigated this as part of the REACH project.

Methods: We undertook a cross-sectional, qualitative study using face-toface, in-depth interviews with a purposively selected sample of 33 PLWH, recruited from five London HIV clinics and via community outreach. Interviews were based on a topic guide developed with reference to the COM-B system. This identifies Capability, Opportunity and Motivation as necessary conditions for enacting behaviour (in this case, engaging in HIV care). We used Framework to analyse the data.

Results: We interviewed 10 regular attenders (all appointments attended in past year), 13 irregular attenders (one or more missed appointments in past year) and 10 non-attenders (previous absence from care of a year or more). They included 9 MSM, 8 heterosexual men and 16 women; 16 under 40 years old; and 13 of black African ethnicity. The following factors were identified as influencing engagement in HIV care. Capability: Feeling unwell or forgetting about appointments undermine patients’ ability to engage whereas empowerment through knowledge has a positive influence. Opportunity: Financial difficulties, work and caring responsibilities, homelessness and immigration issues reduce the opportunity to engage. Opportunity is also shaped by social influences such as fear of disclosure of HIV status when attending clinic, while peer and community support foster engagement in care. Relationships with partners and healthcare professionals can both encourage and deter engagement. Motivation: Denial, feeling well, depression, poor self-esteem and poor adherence to ART create barriers to engagement. Motivation to engage can be reinforced by familiarity with the clinic and strong self-efficacy. ª 2016 The Authors HIV Medicine ª 2016 British HIV Association, HIV Medicine, 17 (Suppl. 1), 14–71 Poster Abstracts 65

Conclusion: The COM-B system suggests that patients need the capability, opportunity and motivation to engage in HIV care. Our interviews have identified multiple factors associated with these necessary conditions that may result in disengagement from care, as well as factors that may facilitate engagement. Our findings suggest no one-size-fits-all method of improving engagement and support the use of a range of approaches to uncover and address these factors.

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