3037 — Veteran perspectives on interventions to improve retention in HIV care

Giordano TP, Houston IQuESt, MEDVAMC; Minick S, Houston IQuESt, MEDVAMC; Stafford C, Houston IQuESt, MEDVAMC; Kertz B, MEDVAMC; Rodriguez-Barradas M, Houston IQuESt, MEDVAMC;

Objectives:
The VA is the largest single provider of HIV care in the US. Poor retention in HIV medical care is one of the primary reasons Veterans die of HIV/AIDS today. There are no proven interventions to better retain Veterans in HIV primary care. We sought to identify the Veteran-centric methods to improve retention in VA HIV care.

Methods:
We conducted focus groups with male outpatient Veterans and one-on-on interviews with female outpatient Veterans living with HIV infection from the Michael E. DeBakey VAMC. We also recruited Veterans hospitalized at MEDVAMC with HIV infection who were presently out of HIV primary care. Interviews were audio recorded and transcribed. Transcriptions were analyzed by three researchers around three focus areas: barriers, facilitators, and interventions to improve retention in care. We also asked for thoughts on how any intervention should be delivered. Emergent themes were coded and analyzed. Analysis was facilitated by Atlas.ti.

Results:
64 veterans participated in an interview or focus group. Relevant priorities to improve retention in care that emerged from the Veterans included: developing an HIV friendly environment at the VA to reduce HIV stigma, increasing awareness about HIV care, making resources available to inform Veterans about HIV care at the VA, and providing mental health and substance treatment support services concurrent with HIV clinical care. Veterans also identified delivery methods that they felt would be effective ways to help HIV infected Veterans. Those methods included video (whether online or delivered in clinic), brochures, pamphlets, and HIV-related posters in clinic, and mass media outlets. Veterans felt that these methods would increase the knowledge of all VA patients about HIV care at the VA and decrease stigma associated with HIV, resulting in increased retention and adherence to HIV care overall. They also strongly endorsed peer supporters, i.e., having the opportunity to speak with another Veteran who has overcome struggles with retention in care, usually focused around mental health, substance use, and HIV fatalism.

Implications:
Veterans' suggestions to improve retention in HIV care focused around greater information, decreasing stigma, and providing peer support.

Impacts:
The research has identified many Veteran-suggested approaches to improving retention in care. These interventions will be developed in further studies.