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This project aims to establish a more detailed understanding of the reasons why PLHIV become disconnected from care and what can be done to facilitate ongoing connection. The NAPWHA Linkage to Care Project (LKCP) aims to identify barriers and facilitators that assist PLHIV in maintaining linkage to care. The findings from the LKCP will fill in part of the picture (from the perspective of PLHIV) about the barriers and facilitators that assist in linking and maintaining care arrangements.
The project will benefit all PLHIV (27,500) in Australia in that findings will lead to an enhanced quality of care and retention. The target population includes wide ranging institutional and individual beneficiaries particularly those PLHIV not in care (9,680). This includes; those for whom current models of care are difficult to engage with, those from a CALD background or who do not speak English, those with chaotic lives, those in regional and remote areas, those with drug and alcohol abuse issues, and those with mental health conditions.
PLHIV who are disconnected from care are significantly more likely to not be receiving ARV therapy and are more likely to have a DVL. Future reductions in HIV transmissions will depend on reducing the number of PLHIV who are disconnected from care. Improved models of care and strategies of retention-in-care are vital to achieving this aim.
Need has been established through several studies identifying reasons for interruption of HIV care; McMahon et al (2015) categorised four groups.
The 1) ‘well but busy’ 2) those encountering structural barriers such as difficulty in attending clinics or financial barriers 3) those experiencing psychosocial barriers including difficulty in accepting HIV diagnosis, and 4) 'others’ including those experiencing negative reactions to care or wanting a break.
Other studies have found attitudes of clinicians, age, time since diagnosis, and availability of welfare supports to be factors associated non-use of antiretroviral therapy.
The primary aim of the project is to develop a more detailed understanding of the reasons why PLHIV become disconnected from care and what can be done to facilitate ongoing connection.
The NAPWHA project will be the first to focus on what counts as good linkage to care from the perspective of PLHIV; that is the barriers and facilitators which affect retention in care as directly experienced by PLHIV and a better understanding of the motivations of PLHIV to stay in care. The project will therefore be able to identify gaps between what PLHIV and care providers think are the barriers and facilitators to access and retention as well as drawing on information from those who have expert experience in developing some strategic responses to the problem.
The LKCP will generate information and data through qualitative interviews with PLHIV and selected service providers. The project will produce a report, reviewed by PLHIV organisations that can be circulated to others who are concerned about this aspect of HIV service care
Date of preparation: November 2016 | AUS/HIV/0016/13(3)e