Factors contributing to dropping out from and returning to HIV treatment in an inner city primary care HIV clinic in the United States

Abstract

Although advances in pharmacotherapy have enabled people living with HIV/AIDS to live longer, fuller lives, some leave medical care, resulting in sub-optimal treatment and increased health risk to themselves and others. Forty-one patients who dropped out of an urban, publically funded primary care HIV clinic were contacted and encouraged by outreach staff to return. Participants were interviewed within two weeks of returning, and themes associated with dropping out and returning were elicited and content analyzed. Dropping out was associated with drug/alcohol use, unstable housing/homelessness, psychiatric disorders, incarceration, problems with HIV medications, inability to accept the diagnosis, relocation, stigma, problems with the clinic, and forgetfulness. Returning was associated with health concerns, substance abuse treatment/recovery, stable housing, incarceration/release, positive feelings about the clinic, spirituality, and assistance from family/relocation. Because a large number of patients reported substance abuse, depression, and past suicide attempts. Clinic staff should assess substance use, depression, and suicidal ideation at each primary care visit and encourage patients to obtain substance abuse treatment and mental health care. Future interventions could include providing SBIRT and/or onsite mental health and substance abuse treatment, all of which may boost retention.

Keywords:

• HIV
• AIDS
• attrition
• retention
• engagement
• substance abuse

Acknowledgements

This research was supported by NIDA P60 DA005186; Charles P. O'Brien, MD, PI. GW, AP, and CRM received support from NIDA U10 DA-13043, and GW received support from NIDA KO5 DA-17009.

Notes

1. Between 7/09 and 1/11, 21% of medical patients received individual or group psychotherapy at the center. Due to interim results of this study indicating high levels of substance use among LTC patients, substance abuse treatment services were initiated onsite in 8/10.