AIDS and Behavior

, Volume 20, Issue 10, pp 2433–2443 | Cite as

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia

  • Anna V. Kuznetsova
  • Anastasia Y. Meylakhs
  • Yuri A. Amirkhanian
  • Jeffrey A. Kelly
  • Alexey A. Yakovlev
  • Vladimir B. Musatov
  • Anastasia G. Amirkhanian
Original Paper

Abstract

Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one’s HIV status, fears of learning about one’s true health status, and substance abuse. Care facilitators were feeling responsible for one’s health and one’s family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one’s doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.

Keywords

Russia Persons living with HIV (PLHIV) HIV-positive HIV medical care HIV services HIV care linkage and retention 

Resumen

Rusia experimenta una importante epidemia de VIH, pero tiene baja retención de las personas VIH positivas en la atención médica. Ochenta personas viviendo con VIH en San Petersburgo completaron entrevistas en profundidad con el fin de identificar barreras y facilitadores en cuanto a estar bajo atención médica del VIH. Las barreras más comúnmente reportadas fueron dificultades en el acceso a proveedores de salud, insatisfacción con la calidad de los servicios de salud, y actitudes negativas de los proveedores de salud. Otras barreras fueron no tener síntomas de enfermedad, experimentar otros estresores vitales, tener una baja valoración de la propia salud, experimentar estigma internalizado y necesitad de esconder el estatus VIH positivo, tener miedo a conocer el propio estado de salud, y usar sustancias. Los facilitadores de mantenerse bajo cuidado médico fueron sentirse responsable por la propia salud y la de la familia, recibir el apoyo de otras personas VIH positivas, y sentir el comienzo de la declinación de la salud y el miedo a la muerte. Además de la buena comunicación con los proveedores de salud y de tener un médico de confianza, la reducción del uso de sustancias facilitó la retención en el cuidado médico. En Rusia, se necesitan intervenciones que tengan en cuenta las barreras de infraestructura en la atención del VIH e integren los servicios de VIH con los psicosociales y de abuso de sustancias.

References

  1. 1.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Rodger A, Bruun T, Cambiano V, et al. for the PARTNER Study Group. HIV transmission risk through condomless sex if HIV + partner on suppressive ART: PARTNER Study [abstract LB-153]. Abstracts from the 2014 conference on retroviruses and opportunistic infections. Top Antivir Med. 2014;22(e-1).Google Scholar
  3. 3.
    Dieffenbach CW, Fauci AS. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA. 2009;301:2380–2.CrossRefPubMedGoogle Scholar
  4. 4.
    Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52:793–800.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Philbin MM, Tanner AE, DuVal A, et al. Factors affecting linkage to care and engagement in care for newly-diagnosed HIV-positive adolescents within fifteen adolescent medicine clinics in the United States. AIDS Behav. 2014;189:1501–10.CrossRefGoogle Scholar
  6. 6.
    Gardner LI, Metsch LR, Anderson-Mahoney P, et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS. 2005;19:423–31.CrossRefPubMedGoogle Scholar
  7. 7.
    Raymond A, Hill A, Pozniak A. Large disparities in HIV treatment cascades between eight European and high-income countries—analysis of break points. J Int AIDS Soc. 2014;17(Suppl 3):19507.PubMedPubMedCentralGoogle Scholar
  8. 8.
    UNAIDS. Treatment 2015. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS, 2015. http://www.unaids.org/sites/default/files/media_asset/JC2484_treatment-2015_en_1.pdf. Accessed May 4, 2015.
  9. 9.
    Russian Federal AIDS Center. Information on HIV Infection in Russian Federation (as of 31 of December, 2014) [in Russian]. http://www.hivrussia.org/files/spravkaHIV2014.pdf. Accessed September 30, 2015.
  10. 10.
    Pokrovskaya A, Popova A, Ladnaya N, Yurin O. The cascade of HIV care in Russia, 2011-2013. J Int AIDS Soc. 2014;17(Suppl 3):19506.PubMedPubMedCentralGoogle Scholar
  11. 11.
  12. 12.
    St. Petersburg AIDS Center. HIV in Saint Petersburg. AIDS Sex Health. 2013; 4:21. http://www.aidsjournal.ru/pdf/txt_2013_04.pdf. Accessed May 4, 2015.
  13. 13.
    Pokrovskiy V. HIV epidemic in Russia and neighbouring countries. J Int AIDS Soc. 2014;17(Suppl 3):19502.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Bhatia R, Hartman C, Kallen MA, Graham J, Giordano TP. Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the Steps Study. AIDS Behav. 2011;15:1161–70.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Bauman LJ, Braunstein S, Calderon Y, et al. Barriers and facilitators of linkage to HIV primary care in New York City. J Acquir Immune Defic Syndr. 2013;64(Suppl 1):S20–6.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Mayer KH. Introduction: linkage, engagement, and retention in HIV care: essential for optimal individual- and community-level outcomes in the era of highly active antiretroviral therapy. Clin Infect Dis. 2011;52(Suppl 2):S205–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Magnus M, Jones K, Phillips G, et al. Characteristics associated with retention among African American and Latino adolescent HIV-positive men: results from the outreach, care, and prevention to engage HIV-seropositive young MSM of color special project of national significance initiative. J Acquir Immune Defic Syndr. 2010;53:529–36.CrossRefPubMedGoogle Scholar
  18. 18.
    Haley DF, Lucas J, Golin CE, for the HPTN 064 Study Team, et al. Retention strategies and factors associated with missed visits among low income women at increased risk of HIV acquisition in the US (HPTN 064). AIDS Patient Care STDS. 2014;28:206–17.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Sprague C, Simon SE. Understanding HIV care delays in the US South and the role of the social-level in HIV care engagement/retention: a qualitative study. Int J Equity Health. 2014;13:28.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Tedaldi EM, Richardson JT, Debes R, et al. Retention in care within 1 year of initial HIV care visit in a multisite US cohort: who’s in and who’s out? J Int Assoc of Provid AIDS Care. 2014;13:232–41.CrossRefGoogle Scholar
  21. 21.
    Nunn A, Cornwall A, Fu J, Bazerman L, Loewenthal H, Beckwith C. Linking HIV-positive jail inmates to treatment, care, and social services after release: results from a qualitative assessment of the COMPASS Program. J Urban Health. 2010;87:954–68.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Giordano TP, Hartman C, Gifford AL, Backus LI, Morgan RO. Predictors of retention in HIV care among a national cohort of US veterans. HIV Clin Trials. 2009;10:299–305.CrossRefPubMedGoogle Scholar
  23. 23.
    Tripathi A, Youmans E, Gibson JJ, Duffus WA. The impact of retention in early HIV medical care on viro-immunological parameters and survival: a statewide study. AIDS Res Hum Retrovir. 2011;27:751–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Torian LV, Xia Q, Wiewel EW. Retention in care and viral suppression among persons living with HIV/AIDS in New York City, 2006–2010. Am J Public Health. 2014;104:e24–9. doi:10.2105/AJPH.2014.302080.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Grabmeier-Pfistershammer K, Rieger A, Schröck T, Schlag M. Economic burden of late presentation in HIV disease in Austria: a comparison of the initial costs imposed by advanced HIV disease vs. non-late presentation. Wien Klin Wochenschr. 2013;125:402–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Fagan JL, Beer L, Garland P, et al. The influence of perceptions of HIV infection, care, and identity on care entry. AIDS Care. 2012;24:737–43.CrossRefPubMedGoogle Scholar
  27. 27.
    McCoy SI. HIV testing and linkage to care in North Carolina: early diagnosis, late diagnosis and delayed presentation to care. [Doctoral dissertation]. Chapel Hill: HIV ATN LTC dissertation database; 2002.Google Scholar
  28. 28.
    Morales-Aleman MM, Sutton MY. Hispanics/Latinos and the HIV continuum of care in the Southern USA: a qualitative review of the literature, 2002–2013. AIDS Care. 2014;26:1592–604.CrossRefPubMedGoogle Scholar
  29. 29.
    Gardner LI, Giordano TP, Marks G, et al. Enhanced personal contact with HIV patients improves retention in primary care: a randomized trial in 6 US HIV clinics. Clin Infect Dis. 2014;59:725–34.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Udeagu CC, Webster TR, Bocour A, Michel P, Shepard CW. Lost or just not following up: public health effort to re-engage HIV-infected persons lost to follow-up into HIV medical care. AIDS. 2013;27:2271–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Aidala AA, Lee G, Abramson DM, Messeri P, Siegler A. Housing need, housing assistance, and connection to medical care. AIDS Behav. 2007;11(Suppl 2):S101–15.CrossRefGoogle Scholar
  32. 32.
    Cunningham CO, Buck J, Shaw F, Seigel LS, Heo M, Agins BD. Factors associated with returning to HIV care after a gap in care in New York State. J Acquir Immune Defic Syndr. 2014;66:419–27.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Kelly JD, Hartman C, Graham J, Kallen MA, Giordano TP. Social support as a predictor of early diagnosis, linkage, retention, and adherence to HIV care: results from the steps study. J Assoc Nurses AIDS Care. 2014;25:405–13.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bernard HR. Research methods in anthropology: qualitative and quantitative approaches. 2nd ed. Walnut Creek, CA: Sage; 1995.Google Scholar
  35. 35.
    Spradley JP. Participant observation. New York: Holt Rinehart & Winston; 1980.Google Scholar
  36. 36.
    Hall J, Stevens PE. Rigor in feminist research. ANS Adv Nurs Sci. 1991;13:16–29.CrossRefPubMedGoogle Scholar
  37. 37.
    Sandelowski M. The problem of rigor in qualitative research. ANS Adv Nurs Sci. 1986;8:27–37.CrossRefPubMedGoogle Scholar
  38. 38.
    Amirkhanian YA, Kelly JA, Kuznetsova AV, DiFranceisco WJ, Musatov VB, Pirogov DG. People with HIV in HAART-era Russia: transmission risk behavior prevalence, risk predictors, and psychosocial distress. AIDS Behav. 2010;15:767–77.CrossRefGoogle Scholar
  39. 39.
    World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva, Switzerland: WHO; September, 2015. http://apps.who.int/iris/bitstream/10665/186275/1/9789241509565_eng.pdf. Accessed October 12, 2015.
  40. 40.
    Philbin MM, Tanner AE, Duval A, Ellen J, Kapogiannis B, Fortenberry JD. Linking HIV-positive adolescents to care in 15 different clinics across the United States: creating solutions to address structural barriers for linkage to care. AIDS Care. 2014;26:12–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Latkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav. 2010;14(Suppl 2):222–38.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Anna V. Kuznetsova
    • 1
  • Anastasia Y. Meylakhs
    • 1
  • Yuri A. Amirkhanian
    • 1
    • 2
  • Jeffrey A. Kelly
    • 2
  • Alexey A. Yakovlev
    • 1
    • 3
  • Vladimir B. Musatov
    • 1
    • 3
  • Anastasia G. Amirkhanian
    • 1
  1. 1.Botkin Hospital for Infectious DiseasesInterdisciplinary Center for AIDS Research and Training (ICART)St. PetersburgRussia
  2. 2.Department of Psychiatry and Behavioral Medicine, Medical College of WisconsinCenter for AIDS Intervention Research (CAIR)MilwaukeeUSA
  3. 3.Faculty of MedicineSt. Petersburg State UniversitySt. PetersburgRussia

Personalised recommendations