Grant: Travel Awards - Institute Community Support

Women living with HIV in high-income counties continue to experience barriers to care. Our research was aimed at identifying features of care that help women meet their health care needs. Comprehensive care for women living with HIV includes HIV-specific care, multiple screenings and management, and sexual and reproductive health. We reviewed the scientific literature, using a systematic mixed studies review design (qualitative, mixed methods and quantitative studies) identified in Ovid MEDLINE, EMBASE, and CINAHL databases. We limited the review to articles published between January 2000 and August 2017. Articles had to pertain to: women living with HIV; high-income countries; primary care; and health care accessibility. Using NVivo software we identified major themes. We situated the themes across three levels of the healthcare system: care providers; clinical care environments; and social and institutional factors. After screening 3,466 records, we retained 44 articles and identified 13 themes. At the care provider level, features enhancing access to comprehensive primary care included: positive patient-provider relationships and availability of peer support, case managers and/or nurse navigators. Within the clinical care environment, facilitators to care were: appointment reminder systems, non-identifying clinic signs, women and family spaces, transportation services, and coordination of care to meet women's HIV, co-morbidity, and sexual and reproductive healthcare needs. Finally, social and institutional factors included healthcare insurance, patient and physician education on HIV and women's health, and efforts to dispel HIV-related stigma. This review highlights several features of care that are particularly relevant to the care seeking experience of women living with HIV. Improving their health through comprehensive care requires a variety of strategies at the provider, clinic, and greater social and institutional levels.