Barriers and facilitators to engagement in care and medication adherence for women living with HIV in the Southern United States

Women living in the South have the second highest rate of HIV and the lowest rate of viral suppression among women in all regions in the United States (U.S.). Viral suppression is achieved by successfully linking women to HIV care and supporting adherence to antiretroviral therapy (ART). We aimed to qualitatively explore perceived barriers and facilitators to HIV care engagement and ART adherence among women living with HIV in the South. Participants (N = 40) were recruited across a broad geographic area of the South, assisted by a location-specific Community/Clinician Advisory Board (CCAB). Qualitative research methods were used to generate in-depth descriptions of women's experiences in accessing HIV care and adhering to ART. Intrapersonal qualities expressed through resilience and self-efficacy were amongst the most prominent themes for both engagement in care and adherence to medications. Structural barriers such as transportation and distance to care continued to be a barrier to engagement, while medication delivery facilitated adherence. Conclusion: Our findings highlight the complexity and interrelated nature of factors impacting care and adherence. Multilevel interventions that incorporate structural factors in addition to individual-level behavioral change are needed to facilitate engagement in care and adherence to ART.

Peer advice for women living with HIV in the Southern USA

Peer advice can provide emotional, social and practical assistance for the sustained self-management of chronic conditions. For stigmatised diseases such as HIV, finding support can be challenging. Women living with HIV in the Southern USA are additionally impacted upon by region-specific barriers such as stigma, poverty and limited access to services. The effectiveness of peer advice has been studied, yet little is known about the advice shared amongst women living with HIV. Therefore, we aimed to qualitatively explore the context and content of the advice participants offered to other women. With the assistance of a Community Clinician Advisory Board, women were recruited from across the US Centers for Disease Control and Prevention South Census Region. In-depth interviews were conducted with (N = 40) participants, aged 23 to 72 years (M = 51.2). Qualitative inductive thematic analysis was used to explore both the solicited and unprompted advice shared during individual interviews. Analysis of interview transcripts revealed three advice themes: Consistency in disease management Practical, non-medical advice; and Emotional and social support. The findings are valuable in shaping future peer-delivered programmes and interventions to enhance HIV care engagement, medication adherence, and the well-being of women living with HIV in the Southern USA.