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Sanders TN, Roed AKH, Missel M, Berg SK, Nielsen SD, Olesen ML, Kirk O. Barriers to Retention in Care among Adults with HIV in Developed Countries: An Integrative Review. AIDS Behav 2025:10.1007/s10461-025-04685-z. [PMID: 40185958 DOI: 10.1007/s10461-025-04685-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2025] [Indexed: 04/07/2025]
Abstract
Focusing on factors hindering viral suppression is essential for improving the health outcomes of people with Human Immunodeficiency Virus (HIV) and working towards ending the HIV/AIDS epidemic. The aim of this integrative review is to create an overview of barriers to retention in care among adults with HIV living in developed countries. Based on a systematic literature search across EMBASE, PubMed, Scopus, CINAHL, and PsycInfo, 4,089 studies of various methodology were identified. A total of 52 studies met the inclusion criteria. Quality assessment was performed using the Mixed Method Appraisal Tool. Based on thematic analysis, the following five main themes were identified as most common barriers to retention in care: financial challenges, logistical challenges, stigma, mental health problems, and substance use. The integrative review highlights that various factors can hinder retention in care and underscores that strategies to promote retention in care should be person-centered and targeted the individual person's barriers to retention in care.
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Affiliation(s)
- Tea Nynne Sanders
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Anna Katrine Haslund Roed
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Malene Missel
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Heart and Lung Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne Dam Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Linnet Olesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Interdiciplinary Research Unit for Womens, Childrens and Families Health Dept. 94A-2-2/Department of Gynaecology, Fertility and Births, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ole Kirk
- Department of Infectious Diseases, Copenhagen University Hospital Rigshospitalet, Esther Møllers Vej 6, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Vincent W, Siconolfi DE, Pollack L, Campbell CK, Kegeles SM, Storholm ED. What's in Your Dataset? Measuring Engagement in HIV Care Using Routinely Administered Items with a Population Disproportionately Burdened by HIV. AIDS Behav 2024; 28:1423-1434. [PMID: 38150065 DOI: 10.1007/s10461-023-04229-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/28/2023]
Abstract
We evaluated the psychometric properties of a measure consisting of items that assess current HIV care continuum engagement based on established definitions in the United States. At baseline, participants in this longitudinal study, which included three time points from 2015 to 2020, were 331 young Black sexual minority men ages 18-29 living with HIV in the southern United States residing in two large southern cities. Self-report items reflected four aspects of HIV care continuum engagement as binary variables: seeing a healthcare provider for HIV care, being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. Of these, the following three variables loaded onto a single factor in exploratory factor analysis: being on antiretroviral treatment, being retained in HIV care, and being virally suppressed. A one-dimensional factor structure was confirmed using confirmatory factor analyses at separate time points. Additionally, the three items collectively showed measurement invariance by age, education level, employment status, and income level. The three-item measure also showed reliability based on coefficient omega and convergent validity in its associations with indicators of socioeconomic distress, depression, resilience, and healthcare empowerment. In sum, the items performed well as a single scale. The study demonstrated the potential psychometric strength of simple, feasible, commonly administered items assessing engagement in the HIV care continuum.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Weiss Hall, Philadelphia, PA, 19122, USA.
| | | | - Lance Pollack
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Chadwick K Campbell
- Herbert Wertheim School of Public Health and Human Longevity, University of California, San Diego, CA, USA
| | - Susan M Kegeles
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA
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