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AIDS Patient Care STDS. 2017 Dec;31(12):495-503. doi: 10.1089/apc.2017.0124. Epub 2017 Nov 17.

Exploring the Healthcare Environment and Associations with Clinical Outcomes of People Living with HIV/AIDS.

Author information

1
1 Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania.
2
2 School of Medicine, University of Pittsburgh , Pittsburgh, Pennsylvania.
3
3 Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania.
4
4 Center for Inclusion Health , Allegheny Health Network, Pittsburgh, Pennsylvania.
5
5 UPMC Center for High-Value Health Care , Pittsburgh, Pennsylvania.

Abstract

Despite three decades of dramatic treatment breakthroughs in antiretroviral regimens, clinical outcomes for people living with HIV vary greatly. The HIV treatment cascade models the stages of care that people living with HIV go through toward the goal of viral suppression and demonstrates that <30% of those living with HIV/AIDS in the United States have met this goal. Although some research has focused on the ways that patient characteristics and patient-provider relationships contribute to clinical adherence and treatment success, few studies to date have examined the ways that contextual factors of care and the healthcare environment contribute to patient outcomes. Here, we present qualitative findings from a mixed-methods study to describe contextual and healthcare environment factors in a Ryan White Part C clinic that are associated with patients' abilities to achieve viral suppression. We propose a modification of Andersen's Behavioral Model of Health Services Utilization, and its more recent adaptation developed by Ulett et al., to describe the ways that clinic, system, and provider factors merge to create a system of care in which more than 86% of the patient population is virally suppressed.

KEYWORDS:

AIDS; HIV; medication adherence; patient care

PMID:
29148966
PMCID:
PMC5724582
DOI:
10.1089/apc.2017.0124
[Indexed for MEDLINE]
Free PMC Article

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