“Take care of their hierarchy of needs first”: strategies used by data-to-care staff to address barriers to HIV care engagement

ABSTRACT

Data-to-Care (D2C) is a public health strategy designed to engage out-of-care (OOC) persons with HIV (PWH) in HIV care. OOC PWH are identified through review of state and local HIV data and engaged in care through individualized efforts that address barriers to HIV care. Perspectives of D2C program staff can contribute to D2C program development and sustainability. We conducted semi-structured interviews in 2017 with 20 D2C program staff from Louisiana (n = 10) and Virginia (n = 10), states with distinct D2C programs. We used content and thematic analysis to analyze interview transcripts. In both states, common barriers to care for OOC PWH include limited transportation, stigma, substance use, poverty, homelessness, and mental illness. To address these barriers and engage OOC clients in HIV care, staff and programs provided transportation vouchers and housing assistance, integrated substance use and mental health services into care engagement processes, provided empathy and compassion, and assessed and addressed basic unmet needs. Identifying and addressing social and structural barriers to HIV care is a critical and often a necessary first step in engaging OOC clients in HIV care. These findings can be used for D2C program design and implementation, facilitating engagement in HIV care for OOC PWH.

KEYWORDS:

• HIV
• surveillance
• program
• data to care
• qualitative analyses

Acknowledgements

Some authors are federal government employees, and this report is not subject to copyright in the United States. Special thanks to Nanette Benbow, PhD (Northwestern University Feinberg School of Medicine), the Louisiana Department of Health – Office of Public Health Region 1 and Region 2 offices, the Virginia Department of Health, the D2C program staff in Louisiana and Virginia, and the study team who collected and analyzed the data.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was conducted under CDC Contract #200-2013-57341/0004.Centers for Disease Controls and Prevention (CDC)