HIV MAPPING Study - Preliminary Results: Qualitative Semi-Structured InterviewsQ. Barnette, B. Witt, M. Coffman, M. Dulin, C. Burns, P. Robinson

In-depth key informant (KI) interviews● To qualitatively characterize barriers to prevention of HIV

and care for people living with HIV in Mecklenburg County.

● Identify key areas to focus future intervention efforts.

BACKGROUND OBJECTIVE METHODS

RESULTS

CONCLUSIONS

Rates of persons living with HIV 2014

AidsVu Map of HIV Prevalence in Meck Co. by Zip Code:PLWH/100,000

HIV epidemic centered in Southeastern USA

● Major cities including Charlotte (Mecklenburg County), NC.

● People living with HIV: 6,232.● 72% men and 28% women.● New diagnoses: 282. ● New diagnoses between 2011 and 2015: 69% Black, 9%

Hispanic/Latino, and 17% White.● Areas of increased prevalence in Meck Co.

In-depth qualitative interviews with 19 KI• July to November, 2017

– HIV Outreach Screeners– Patient Navigators– Case Managers– Ryan White Administration– Epidemiologists– STD Clinic Staff– Physicians– Engaged community members

• Thematic content analysis employed a grounded theoretical approach– NVivo software was used– Team analysis through immersion-crystallization.

• Findings validated via peer debrief

Results: Theme and Subtopic Frequencies are Represented by Relative Polygon Size

Key priorities that emerged– PrEP accessibility– Education and knowledge of HIV– Sensitive and centralized care needed– Social needs such as housing and addressing stigma– Community coordination is imperative.

• Steps to corroborate the data with HIV patient interviews and a subsequent action plan are needed.

Screening & Preventive Care● Need proactive approach to

preventive care● Improvement reaching key

populations● Safe space for LGBTQ+ of

color● Testing Privacy

Communication● Lack of protocol to

achieve rapid linkage to care and support services

● Competition for funding makes for inefficiencies

Concurrent Social Needs● Poverty and transience

main drivers of transmission due to poor access to education, care, and support services

Awareness/Community Education

● Lacking coordination● Lack of inclusive sexual

education/STI prevention ● Misinformation still exists

Behavioral Health● Need patient

self-management and agency within the “continuum of care”

Access● Care centralization and

sensitivity● Lack of transportation● Lack of patient navigation

services● PrEP Accessibility

Structure Design● Testing/counseling/treatmen

t separate & fragmented ● Significant competition for

funding ● Emergency Services

over-utilized

Support Services● Screening privacy is lacking● Do not accommodate a

variety of experiences and identities

Cultural Competency● Medical community

engagement necessary for retention of diverse communities

● Medical mistrust prevalent● Profound generational

differences in urgency

Concurrent Medical Needs● HCV and Syphilis

prevention and treatment are frequent concurrent needs

Funding● Funding for services is

limited and complicated to obtain

● Renewing ADAP services is frequent and may require assistance

● Lack of health insurance is prevalent

“They had no place to receive medicines,

no place to safely store medicines”

“So, the more rapidly these can be condensed – so if testing and counseling and starting all occur at the same time, the closer in proximity those are, the more retention and engagement we have.”

“Housing is a tremendous

issue““a hard time staying compliant”