Barriers and facilitators to engagement of vulnerable populations in HIV Primary Care in New York City

Robert H. Remien, Laurie J. Bauman, Joanne E. Mantell, Benjamin Tsoi, Javier Lopez-Rios, Rosy Chhabra, Abby Di Carlo, Dana Watnick, Angelic Rivera, Nehama Teitelman, Blayne Cutler, Patricia Warne

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Background: Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, whereas nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. Methods: We conducted 80 in-depth qualitative interviews with PLWH in 4 New York City populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Results: Barriers to and facilitators of HIV care engagement fell into 3 domains: (1) system factors (eg, patient-provider relationship, social service agencies, transitions between penal system and community), (2) social factors (eg, family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration), and (3) individual factors (eg, mental illness, substance use, resilience). Similarities and differences in these themes across the 4 populations as well as research and public health implications were identified. Conclusions: Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed, patient-provider communication is strong, and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation.

Original languageEnglish (US)
Pages (from-to)S16-S24
JournalJournal of Acquired Immune Deficiency Syndromes
Volume69
DOIs
StatePublished - May 1 2015

Fingerprint

Vulnerable Populations
Primary Health Care
HIV
Acquired Immunodeficiency Syndrome
Transgender Persons
Viral Load
Social Work
Sexual Behavior
Social Support
Population
Mental Health
Public Health
Communication
Interviews
Morbidity
Mortality
Research

Keywords

  • African immigrants
  • HIV care engagement
  • Previously incarcerated adults
  • Transgender women
  • Young men who have sex with men

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Barriers and facilitators to engagement of vulnerable populations in HIV Primary Care in New York City. / Remien, Robert H.; Bauman, Laurie J.; Mantell, Joanne E.; Tsoi, Benjamin; Lopez-Rios, Javier; Chhabra, Rosy; Di Carlo, Abby; Watnick, Dana; Rivera, Angelic; Teitelman, Nehama; Cutler, Blayne; Warne, Patricia.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 69, 01.05.2015, p. S16-S24.

Research output: Contribution to journalArticle

Remien, RH, Bauman, LJ, Mantell, JE, Tsoi, B, Lopez-Rios, J, Chhabra, R, Di Carlo, A, Watnick, D, Rivera, A, Teitelman, N, Cutler, B & Warne, P 2015, 'Barriers and facilitators to engagement of vulnerable populations in HIV Primary Care in New York City', Journal of Acquired Immune Deficiency Syndromes, vol. 69, pp. S16-S24. https://doi.org/10.1097/QAI.0000000000000577
Remien, Robert H. ; Bauman, Laurie J. ; Mantell, Joanne E. ; Tsoi, Benjamin ; Lopez-Rios, Javier ; Chhabra, Rosy ; Di Carlo, Abby ; Watnick, Dana ; Rivera, Angelic ; Teitelman, Nehama ; Cutler, Blayne ; Warne, Patricia. / Barriers and facilitators to engagement of vulnerable populations in HIV Primary Care in New York City. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 69. pp. S16-S24.
@article{53c29a2936194e00a80f9774b8526377,
title = "Barriers and facilitators to engagement of vulnerable populations in HIV Primary Care in New York City",
abstract = "Background: Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41{\%} of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, whereas nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. Methods: We conducted 80 in-depth qualitative interviews with PLWH in 4 New York City populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Results: Barriers to and facilitators of HIV care engagement fell into 3 domains: (1) system factors (eg, patient-provider relationship, social service agencies, transitions between penal system and community), (2) social factors (eg, family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration), and (3) individual factors (eg, mental illness, substance use, resilience). Similarities and differences in these themes across the 4 populations as well as research and public health implications were identified. Conclusions: Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed, patient-provider communication is strong, and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation.",
keywords = "African immigrants, HIV care engagement, Previously incarcerated adults, Transgender women, Young men who have sex with men",
author = "Remien, {Robert H.} and Bauman, {Laurie J.} and Mantell, {Joanne E.} and Benjamin Tsoi and Javier Lopez-Rios and Rosy Chhabra and {Di Carlo}, Abby and Dana Watnick and Angelic Rivera and Nehama Teitelman and Blayne Cutler and Patricia Warne",
year = "2015",
month = "5",
day = "1",
doi = "10.1097/QAI.0000000000000577",
language = "English (US)",
volume = "69",
pages = "S16--S24",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Barriers and facilitators to engagement of vulnerable populations in HIV Primary Care in New York City

AU - Remien, Robert H.

AU - Bauman, Laurie J.

AU - Mantell, Joanne E.

AU - Tsoi, Benjamin

AU - Lopez-Rios, Javier

AU - Chhabra, Rosy

AU - Di Carlo, Abby

AU - Watnick, Dana

AU - Rivera, Angelic

AU - Teitelman, Nehama

AU - Cutler, Blayne

AU - Warne, Patricia

PY - 2015/5/1

Y1 - 2015/5/1

N2 - Background: Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, whereas nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. Methods: We conducted 80 in-depth qualitative interviews with PLWH in 4 New York City populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Results: Barriers to and facilitators of HIV care engagement fell into 3 domains: (1) system factors (eg, patient-provider relationship, social service agencies, transitions between penal system and community), (2) social factors (eg, family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration), and (3) individual factors (eg, mental illness, substance use, resilience). Similarities and differences in these themes across the 4 populations as well as research and public health implications were identified. Conclusions: Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed, patient-provider communication is strong, and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation.

AB - Background: Engagement in HIV care helps to maximize viral suppression, which in turn, reduces morbidity and mortality and prevents further HIV transmission. With more HIV cases than any other US city, New York City reported in 2012 that only 41% of all persons estimated to be living with HIV (PLWH) had a suppressed viral load, whereas nearly three-quarters of those in clinical care achieved viral suppression. Thus, retaining PLWH in HIV care addresses this central goal of both the US National HIV/AIDS Strategy and Governor Cuomo's plan to end the AIDS epidemic in New York State. Methods: We conducted 80 in-depth qualitative interviews with PLWH in 4 New York City populations that were identified as being inconsistently engaged in HIV medical care: African immigrants, previously incarcerated adults, transgender women, and young men who have sex with men. Results: Barriers to and facilitators of HIV care engagement fell into 3 domains: (1) system factors (eg, patient-provider relationship, social service agencies, transitions between penal system and community), (2) social factors (eg, family and other social support; stigma related to HIV, substance use, sexual orientation, gender identity, and incarceration), and (3) individual factors (eg, mental illness, substance use, resilience). Similarities and differences in these themes across the 4 populations as well as research and public health implications were identified. Conclusions: Engagement in care is maximized when the social challenges confronted by vulnerable groups are addressed, patient-provider communication is strong, and coordinated services are available, including housing, mental health and substance use treatment, and peer navigation.

KW - African immigrants

KW - HIV care engagement

KW - Previously incarcerated adults

KW - Transgender women

KW - Young men who have sex with men

UR - http://www.scopus.com/inward/record.url?scp=84988878382&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988878382&partnerID=8YFLogxK

U2 - 10.1097/QAI.0000000000000577

DO - 10.1097/QAI.0000000000000577

M3 - Article

C2 - 25867774

AN - SCOPUS:84988878382

VL - 69

SP - S16-S24

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

ER -