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Persisting in HIV Care

CE / CME

Persisting in Care: Ensuring HIV Services Are Inclusive and Equitable

Nurses: 1.00 Nursing contact hour

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Released: September 12, 2024

Expiration: September 11, 2025

Samantha Hill
Samantha Hill, MD, MPH
Chetasi Talati
Chetasi Talati, MD
CME/CE Information

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Wellness Can Be a Facilitator and a Barrier to HIV Care

A concept I like to discuss with my patients is “awesomeness,” by which I mean wellness—feeling well overall. More and more studies are coming out on what it means to be well, particularly in the setting of living with HIV. I think it is really important to think through what it means to be well because wellness and feeling healthy are key to staying engaged in care.

A particular study from Hennink and colleagues10 among people living with HIV from the Atlanta Veterans Medical Center used qualitative interviews to examine who dropped out of care and why. It is a smaller study, but they used the interviews to design a model that demonstrates the relationship between wellness and illness and how that affected attendance of HIV care visits.

In their model, an individual’s perception of wellness affects what their priorities are. Depending on what their priorities are, their perception of wellness may become a clinic-level barrier, which can lead to missed visits.10

In other words, wellness can be a barrier to care if patients feel too sick to attend their appointments.10

However, lack of medication can also create a structural barrier to care. Patients may think, “I’m having so much trouble getting my medication. It’s always such a hassle. It’s never ready for me. The pharmacy is always giving me challenges.” Discouragement regarding access to their medication can create structural barriers that can lead to missed clinic visits.10

Counterintuitively, feeling well may also lead to disengagement from care. Patients may think, “I feel well. I’m not sick. I feel better than I’ve ever been feeling before, especially since getting this diagnosis.” It is up to HCPs to help patients understand that feeling well is because of consistently taking their medicine and to help them understand that feeling well does not mean that they no longer need to persist in HIV care.10

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Addressing Misconceptions

Continuing with the theme of addressing misinformation and misconceptions, how do we show patients that HIV clinics are not just places you go to get diagnosed?

The solution is to turn HIV clinics into holistic centers. This goes back to the idea of c-locating services, including other medical services, social support, and mental health care. Creating a holistic environment will help people realize that HIV care is part of their routine, preventive care.3,11

Another issue is how HIV care can sometimes be less focused on shared decision-making with patients, with communication only going one way. Sometimes, HCPs can get caught up in thinking that we know what is best for the patient. Instead, we should be involving people living with HIV in every aspect of care and every aspect of the workflow of our systems.

For example, does the clinic provide a welcoming environment, from walking in the door, to walking out the door, and everything between? Many factors that make the clinic an unwelcoming environment may go unnoticed by people without HIV. Even something as simple as asking people the same questions about sexual behavior too many times can be triggering for people living with HIV, which makes them not want to come back into care. Involving people living with HIV in HIV care can help with practicing trauma-informed care and can identify things can be triggering.3,11

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