Evaluation of the Facilitators and Barriers to Achieving Targets on the HIV Continuum of Care

Abstract

Key targets on the HIV Continuum of Care include diagnosis, receiving HIV-specific care, and viral suppression. However, many persons living with HIV are not reaching these important thresholds. The goal of this dissertation was to examine facilitators and barriers to achieving these steps on the HIV Continuum of Care. First, I examined the role of user engagement with three major components of Thrive with Me (TWM), an mHealth intervention, on viral suppression. Among users, engagement with the TWM intervention was high. High overall engagement with TWM was found to be associated with viral suppression at the end of the active intervention period. Of the individual TWM components, only engagement with asynchronous peer exchanges was associated with achieving viral suppression. Second, I evaluated the relationship between individual-level and social-level factors on patient activation, a measure of an individual’s ability to be engaged with their health care, among a sample of men who have sex with men living with HIV. Overall patient activation was high in this sample. Social support and antiretroviral therapy (ART) related information, motivation, and behavioral skills may increase patient activation while increased life chaos, perceived stress, HIV-related stigma, and stimulant drug use may decrease patient activation. Finally, I examined the association of individual, social, and structural level facilitators and barriers to engagement in care among Ethiopians initiating HIV care. Decreased HIV knowledge, the inability to carry out normal activities, social isolation, and transportation were barriers to being retained in HIV care within one-year of initiating HIV treatment. In the long-term, HIV disclosure and social support may facilitate sustained engagement in HIV care. The results of the manuscripts presented in this dissertation help to identify potential areas of intervention to improve steps on the HIV Continuum of Care, including retention in care and viral suppression.