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

The purpose of this research study was to develop a theoretical framework to explain the psychosocial process of care initiation in individuals living with HIV, and to identify the critical junctures that influence individuals living with HIV in their decision to initiate HIV care. Grounded theory method was used to identify the psychosocial process of care initiation by individuals living with HIV. Thirty individuals living with HIV (28 men, 2 women) shared their stories about initiating HIV care. Participants described a process in which they progressed through five distinct stages following diagnosis: a) receiving the news, b) interpreting the news, c) incorporating the news, d) acting on the news, and e) moving beyond the news. Each stage was moderated by influential factors including perceived susceptibility to HIV infection, symptoms, HIV information, and feedback from others. The participants were able to translate the news, from something bad into something good, as demonstrated in the constructed framework: "Translating the News: A Grounded Theory of HIV Care Initiation" A key to successful care initiation is helping individuals with HIV to realize that while the diagnosis may seem like bad news, there is also good news: HIV is not a death sentence. Keywords: Grounded Theory, HIV, Care Initiation, HIV Treatment, HIV Care, HIV Care InitiationThroughout 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, & Zuniga, 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. …