Lost-to-care and engaged-in-care HIV patients in Leningrad Oblast, Russian Federation: barriers and facilitators to medical visit retention

Abstract

Sixty-nine percent of the 1.5 million Eastern Europeans and Central Asians with HIV live in the Russian Federation. Antiretroviral therapy (ART) is effective but cannot help those who leave treatment. Focus groups with patients who dropped out of ART for ≥12 months (lost-to-care, LTCs, n = 21) or continued for ≥12 months (engaged-in-care; EICs; n = 24) were conducted in St. Petersburg. Structural barriers included stigma/discrimination and problems with providers and accessing treatment. Individual barriers included employment and caring for dependents, inaccurate beliefs about ART (LTC only), side-effects, substance use (LTCs, present; EICs, past), and depression. Desire to live, social support, and spirituality were facilitators for both; EICs also identified positive thinking and experiences with ART and healthcare/professionals. Interventions to facilitate retention and adherence are discussed.

Keywords:

• HIV
• AIDS
• retention
• attrition
• Russian Federation
• positive psychology

Acknowledgments

We would like to thank the participants, Botkin Hospital, and Leningrad Regional AIDS Center. This study was supported by funding from the Office of the US Global AIDS Coordinator through the PEPFAR program.

Notes

1. This could reflect under-reporting due to a cultural perception of regular alcohol use as normative, as rates of alcohol abuse are known to be high in the RF (Zaigrayev, 2010).