Enroling and retaining human immunodeficiency virus (HIV) patients in their care: A metasynthesis of qualitative studies.
Dalmacio Flores, Natalie Leblanc, Julie Barroso
PMID 27494428WHAT IT FOUND
People with HIV often delayed or dropped care because of denial, shame, stigma, provider disrespect, family rejection, work and money pressures, and clinic barriers.
Extended counselling, active referral and case management were reported as helpful.
Key findings
01After diagnosis, denial, shame, fear of stigma and uncertainty were reported as reasons people delayed care, while feeling well could lead to missed appointments.
02Patient education, extended post-test counselling, active referrals and case management were reported as ways that helped people link to and stay in HIV care.
03Provider condescension, broken confidentiality, family rejection, competing work and money demands, and inconvenient or fragmented clinic services were reported as barriers to care.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a metasynthesis of qualitative experiences, not a test of whether any intervention works. The authors did not appraise the quality of the included studies, so readers cannot judge how reliable each study was. Only English, peer-reviewed studies from 2008 to 2013 in three databases were included, so newer, grey or non-English literature was not covered. The included studies were from many countries and settings, so themes may not fit every clinic, health system or patient group. The papers report what patients, families and providers said happened, not measured care outcomes or retention rates.
The easy way to misread this
Do not read these themes as proof that post-test counselling, active referral or case management were tested and shown to keep patients in HIV care. The paper summarizes what people said helped or hindered care, not the results of an intervention trial.