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Review
. 2015;27(7):817-28.
doi: 10.1080/09540121.2015.1009362. Epub 2015 Feb 11.

Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen's Behavioral Model

Carol W Holtzman  1 , Judy A Shea, Karen Glanz, Lisa M Jacobs, Robert Gross, Janet Hines, Karam Mounzer, Rafik Samuel, Joshua P Metlay, Baligh R Yehia
Affiliations
Review

Mapping patient-identified barriers and facilitators to retention in HIV care and antiretroviral therapy adherence to Andersen's Behavioral Model

Carol W Holtzman et al. AIDS Care. 2015.

Abstract

Andersen's Behavioral Model (ABM) provides a framework for understanding how patient and environmental factors impact health behaviors and outcomes. We compared patient-identified barriers/facilitators to retention in care and antiretroviral therapy (ART) adherence and evaluated how they mapped to ABM. Qualitative semi-structured interviews with 51 HIV-infected adults at HIV clinics in Philadelphia, PA, in 2013 were used to explore patients' experiences with HIV care and treatment. Interview data were analyzed for themes using a grounded theory approach. Among those interviewed, 53% were male and 88% were nonwhite; 49% were retained in care, 96% were on ART, and 57% were virally suppressed. Patients discussed 18 barriers/facilitators to retention in care and ART adherence: 11 common to both behaviors (stigma, mental illness, substance abuse, social support, reminder strategies, housing, insurance, symptoms, competing life activities, colocation of services, provider factors), 3 distinct to retention (transportation, clinic experiences, appointment scheduling), and 4 distinct to adherence (medication characteristics, pharmacy services, health literacy, health beliefs). Identified barriers/facilitators mapped to all ABM domains. These data support the use of ABM as a framework for classifying factors influencing HIV-specific health behaviors and have the potential to inform the design of interventions to improve retention in care and ART adherence.

Keywords: Andersen's Behavioral Model; adherence; antiretroviral therapy; barriers; retention in care.

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Figures

Figure 1(a)
Figure 1(a)
The Andersen Model of Health Care Utilization (adapted) (Andersen, 1995)
Figure 1(b)
Figure 1(b)
Map of 18 identified barriers/facilitators to retention and adherence
See this image and copyright information in PMC

References

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