1. A Qualitative Investigation of Patients’ Transitional States of Engagement in HIV-Related Medical Care Stephanie Koch, MS, Mary Gerkovich, PhD, Karen Williams, PhD, Julie Banderas, PharmD Introduction Engagement in care following an HIV positive diagnosis carries essential clinical and public health implications, including: careful management of the disease minimization of viral load, maintenance of a healthy CD4 count transmission prevention Patients experience difficulty staying engaged in care and often transition into and out of care. Objective Discover factors related to engagement in HIV- related medical care with emphasis on transitions into and out of care. Methods Qualitative study based on sesmi-structured individual interviews. Interviews were transcribed and independently coded for themes by two of the investigators All coding was fully reconciled Sample HIV+ individuals who have had periods of non-engagement in medical care. n = 22 50% male 50% Black Time since diagnosis: 2-26 yrs 22% (n=5) living with HIV for >20 yrs Results Six main themes emerged from the data Each contained subthemes that describe the issues more specifically. Factors related to transitions in engagement varied greatly among individuals Major themes that were reported by the majority of individuals include the following factors: Conclusion Factors that enable or hinder care engagement vary among HIV-positive persons; the data demonstrate that a deterrent for one patient may act as a motivator for another. Factors related to engagement should be individualized, based on evaluation upon care entry and during each subsequent contact. Findings support an existing framework and indicate the need for evaluation of funding priorities, as well as changes at the health care system and policy levels. Our conceptual framework addresses engagement transitions and can help providers, case managers, clinic staff, and administrators understand the complexity of factors to be accounted for when developing efforts to support better engagement in care. Acknowledgement Research supported by a grant from the University of Missouri Research Board. Thanks to our TMC colleagues. Figure 1. Overlap of factors related to engagement in care General Clinic FactorsPersonal FactorsSupport Factors Clinic factorsRecognition of HIV statusAccess to information Follow-up and outreachDomestic responsibilitiesCase manager assistance Lack of coordination with medicationsFeeling overwhelmed by HIV statusAct to benefit or please others Scheduling difficultiesImpact of stigmaSupport programs PCP lacks HIV treatment knowledgeMental and emotional stability Trying to avoid health care system Using previous success as motivation Health FactorsResourcesTreatment Factors Desire for positive health statusEmployment statusBurden of Treatment Health is OK-no need for careFinancial issuesEffects and expectations of ARVs Health perceptionHomelessness or unstable housing Health problemsAcquiring and keeping services Make HIV part of regular health careTransportation Taking care of routine medical careIncarceration