Academic journal article The Qualitative Report

Translating the News: A Grounded Theory of Care Initiation by Individuals Living with HIV

Academic journal article The Qualitative Report

Translating the News: A Grounded Theory of Care Initiation by Individuals Living with HIV

Article excerpt

Throughout the last three decades, global health authorities have worked tirelessly to understand, control, prevent, and treat Human Immunodeficiency Vims (HIV). Antiretroviral therapy (ART) has the potential to increase lifespan, promote viral suppression, and decrease the likelihood of advancement to acquired immunodeficiency syndrome (CDC, 2012; DHHS, 2013a). In addition to the individual patient benefits, communities benefit from HIV treatment as it decreases the likelihood of HIV transmission (CDC, 2012; DHHS, 2013a; Louie & Markowitz, 2002; Siegfried, Uthman, & Rutherford, 2010). US data indicate that less than half of people living with HIV are achieving optimal treatment outcomes (CDC, 2014; Cheever, 2007; DHHS, 2013b; Gardner, McLees, Steiner, del Rio, & Burman, 2011). As such, there is an urgent need for scientists to investigate factors that lead individuals with HIV to initiate care following diagnosis.

The HIV care continuum, also known as the HIV treatment cascade is a framework that allows clinicians and health authorities to evaluate engagement in HIV care and treatment (DHHS, 2011; Gardner et al., 2011). The continuum is inclusive of all individuals living with HIV, ranging from those who are living with HIV but are unaware of their diagnosis to those who have achieved viral suppression, i.e. the individual's viral load has become undetectable (DHHS, 2011). Care initiation occurs at the cmcial time point on the HIV care continuum when an individual living with HIV takes the action to enter HIV care (Cheever, 2007; Gardner et al., 2011). A greater understanding of factors that influence HIV care initiation will help researchers and clinicians provide optimal transition from HIV diagnosis to treatment, resulting in a greater number of individuals living with HIV who experience the benefits of HIV treatment.

Psychosocial factors are among the many variables that influence individuals newly diagnosed with HIV to pursue HIV care. Psychological response to diagnosis, stigma, and lack of social support, as well as predisposing risk factors such as mental illness and substance misuse have been linked to delayed initiation of HIV care (Burns, Imrie, Nazroo, Johnson, & Fenton, 2007; Kinsler, Wong, Sayles, Davis, & Cunningham, 2007; Marcellin et al., 2009; Pollini, Blanco, Crump, & Zúñiga, 2011; Ramirez-Avila et al., 2012; Reed et al., 2009; Sayles, Wong, Kinsler, Martins, & Cunningham, 2009; Torian, Wiewel, Liu, Sackoff, & Frieden, 2008). Conversely, disease acceptance and tangible and informational support have been found to promote HIV care initiation (Aidala, Lee, Abramson, Messeri, & Siegler, 2007; Craw et al., 2008; Konkle-Parker, 2010; Sprague & Simon, 2014). These studies provide invaluable evidence of the impact of psychosocial factors on HIV care initiation. However, to our knowledge no studies have been reported that examine the psychosocial process of HIV care initiation used by individuals diagnosed with HIV. This study addresses this gap in knowledge by exploring the psychosocial process of HIV care initiation by a group of adults living with HIV.

Author Context

We developed a four-member research team composed of a doctoral candidate (now completed PhD in nursing; first author), a senior faculty member with expertise in the use of the grounded theory method and human social process research (second author), a doctorally trained scientist and research associate (third author), and a research project coordinator with experience in providing legal and social services to low income and disadvantaged individuals (fourth author). The doctoral candidate conducted the study to complete his doctor of philosophy degree in nursing. His interest in HIV was developed through interaction with friends, acquaintances, and patients with HIV, his experience learning about HIV and its treatment in nursing school and in the clinical environment, and through his work with a nurse scientist researching HIV/AIDS. …

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