Barriers and Facilitators to Interventions Improving Retention in HIV Care: A Qualitative Evidence Meta-Synthesis
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Retention in HIV care is vital to the HIV care continuum. The current review aimed to synthesize qualitative research to identify facilitators and barriers to HIV retention in care interventions. A qualitative evidence meta-synthesis utilizing thematic analysis. Prospective review registration was made in PROSPERO and review procedures adhered to PRISMA guidelines. Nineteen databases were searched to identify qualitative research conducted with individuals living with HIV and their caregivers. Quality assessment was conducted using CASP and the certainty of the evidence was evaluated using CERQual. A total of 4419 citations were evaluated and 11 were included in the final meta-synthesis. Two studies were from high-income countries, 3 from middle-income countries, and 6 from low-income countries. A total of eight themes were identified as facilitators or barriers for retention in HIV care intervention: (1) Stigma and discrimination, (2) Fear of HIV status disclosure, (3) task shifting to lay health workers, (4) Human resource and institutional challenges, (5) Mobile Health (mHealth), (6) Family and friend support, (7) Intensive case management, and, (8) Relationships with caregivers. The current review suggests that task shifting interventions with lay health workers were feasible and acceptable. mHealth interventions and stigma reduction interventions appear to be promising interventions aimed at improving retention in HIV care. Future studies should focus on improving the evidence base for these interventions. Additional research is needed among women and adolescents who were under-represented in retention interventions.
KeywordsHIV Retention Care continuum Meta-synthesis ARV
We thank the WHO HIV/AIDS Department and the Guangdong Provincial Centers for Skin Diseases and STI Control for their contribution and support. We would like to thank Zhang Ye, Alice Armstrong, Nathan Ford of the WHO and Simon Lewin of the Norwegian Knowledge Centre for the Health Services for their support during concept development and manuscript review processes.
Compliance with Ethical Standards
Conflicts of interest
All authors declare they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
This project was originally commissioned and supported by the World Health Organization. Additional funding and support was provided by the Macau SAR Government and the University of Macau (SRG-000001-2014-FSS & MYRG2015-00109-FSS, PI: Hall), and (NIAID 1R01AI114310-01 and FIC 1D43TW009532-01, PI: Tucker) from the National Institutes of Health.
- 1.World Health Organization (WHO). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach June 2013. Geneva: World Health Organization; 2013.Google Scholar
- 14.Brookes D. Understanding qualitative research and its value in healthcare. Nurs Timesnet. 2007;103:32–3.Google Scholar
- 15.Hannes K. Chapter 4: Critical appraisal of qualitative research. In: Noyes J, Booth A, Hannes K, et al. editors. Supplementary guidance for inclusion of qualitative research in Cochrane Systematic Reviews of Interventions edition: Version 1. Cochrane Qualitative Research Methods Group; 2011.Google Scholar
- 16.Holloway I, Wheeler S. Qualitative Research in Nursing and Healthcare. New York: Wiley; 2009.Google Scholar
- 19.Programme CAS. Qualitative appraisal checklist for qualitative research. 2006.Google Scholar
- 24.Lewin S, Glenton C, Munthe-Kaas H, Carlsen B, Colvin CJ, Gülmezoglu M, et al. Using qualitative evidence in decision making for health and social interventions: an approach to assess confidence in findings from qualitative evidence syntheses (GRADE-CERQual). Plos Med. 2015;12:e1001895.CrossRefPubMedPubMedCentralGoogle Scholar
- 25.Booth A. Formulating answerable questions. In: Booth A, Brice A, editors. Evidence Based Practice: An Information Professional’s Handbook. London: Facet; 2004. p. 61–70.Google Scholar
- 27.Haley DF, Golin CE, Farel CE, Wohl DA, Scheyett AM, Garrett JJ, et al. Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry. BMC Public Health. 2014;14:1253.CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Quinlivan EB, Messer LC, Adimora AA, Roytburd K, Bowditch N, Parnell H, et al. Experiences with HIV testing, entry, and engagement in care by HIV-infected women of color, and the need for autonomy, competency, and relatedness. AIDS Patient Care STDs. 2013;27:408–15.CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Bezabhe WM, Chalmers L, Bereznicki LR, Peterson GM, Bimirew MA, Kassie DM. Barriers and facilitators of adherence to antiretroviral drug therapy and retention in care among adult HIV-positive patients: a qualitative study from Ethiopia. PLoS ONE. 2014;9:e97353.CrossRefPubMedPubMedCentralGoogle Scholar
- 43.World Bank. Information and Communications for Development: Maximizing Mobile. Washington, DC: World Bank; 2012.Google Scholar
- 45.World Health Organization (WHO). Chapter 4: Organization of Guidelines. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2014. p. 54–66.Google Scholar