abstract: 'Global and national HIV/AIDS policies utilize the care cascade to

  emphasize the importance of continued engagement in HIV services from

  diagnosis to viral suppression. Several studies have documented barriers

  that men experience in accessing services at specific stages of care,

  but few have analyzed how these barriers operate along the care cascade.

  Brazil offers a unique setting for analyzing barriers to HIV care

  because it is a middle-income country with a large HIV epidemic and

  free, universal access to HIV/AIDS services. Semi-structured interviews

  were conducted in 2011 with HIV-infected men (n=25) receiving care at

  the only HIV/AIDS state reference center in Salvador, Brazil, the third

  largest city in the country. Interviews were transcribed and coded for

  analysis. Researchers identified barriers to services along the care

  cascade: health service-related obstacles (poor-quality care, lengthy

  wait times, and drug supply problems); psychosocial and emotional

  challenges (fear of disclosure and difficulty accepting HIV diagnosis);

  indirect costs (transportation and absenteeism at work or school); low

  perceived risk of HIV; and toxicity and complexity of antiretroviral

  drug (ARV) regimens. The stages of the care cascade interrupted by each

  barrier were also identified. Most barriers affected multiple, and often

  all, stages of care, while toxicity and complexity of ARV regimens was

  only present at a single care stage. Efforts to eliminate more prevalent

  barriers have the potential to improve care continuity at multiple

  stages. Going forward, assessing the relative impact of barriers along

  one''s entire care trajectory can help tailor improvements in service

  provision, facilitate achievement of viral suppression, and improve

  access to life-saving testing, treatment, and care.'
affiliation: 'Hoffmann, M (Corresponding Author), Brown Univ, Sch Publ Hlth, 121 South
  Main St,Suite 810, Providence, RI 02912 USA.

  Hoffmann, Michael; Batson, Ashley; Nunn, Amy, Brown Univ, Sch Publ Hlth, Providence,
  RI 02912 USA.

  Hoffmann, Michael; Batson, Ashley; Nunn, Amy, Miriam Hosp, Providence, RI 02912
  USA.

  MacCarthy, Sarah, RAND Corp, Santa Monica, CA 90407 USA.

  Crawford-Roberts, Ann, Icahn Sch Med Mt Sinai, New York, NY 10029 USA.

  Rasanathan, Jennifer, Montefiore Med Ctr, Dept Family \& Social Med, Bronx, NY 10467
  USA.

  Silva, Luis Augusto; Dourado, Ines, Univ Fed Bahia, Inst Collect Hlth, Salvador,
  BA, Brazil.'
author: Hoffmann, Michael and MacCarthy, Sarah and Batson, Ashley and Crawford-Roberts,
  Ann and Rasanathan, Jennifer and Nunn, Amy and Silva, Luis Augusto and Dourado,
  Ines
author-email: michael.tg.hoffmann@gmail.com
author_list:
- family: Hoffmann
  given: Michael
- family: MacCarthy
  given: Sarah
- family: Batson
  given: Ashley
- family: Crawford-Roberts
  given: Ann
- family: Rasanathan
  given: Jennifer
- family: Nunn
  given: Amy
- family: Silva
  given: Luis Augusto
- family: Dourado
  given: Ines
da: '2023-09-28'
doi: 10.1080/09540121.2015.1062462
eissn: 1360-0451
files: []
issn: 0954-0121
journal: AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV
keywords: HIV; AIDS; care cascade; barriers; men; delay; Brazil
keywords-plus: 'ANTIRETROVIRAL THERAPY; DIAGNOSIS; AIDS; PREDICTORS; PREVENTION;

  SPECTRUM; COHORT; ADULTS; SEX; MSM'
language: English
month: JAN 2
number: '1'
number-of-cited-references: '36'
orcid-numbers: 'Dourado, Ines/0000-0003-1675-2146

  Crawford-Roberts, Ann/0000-0002-0630-4430'
pages: 57-62
papis_id: 165f732aa6f5e1b5ba728e8a2b6e476e
ref: Hoffmann2016barrierscare
researcherid-numbers: 'Dourado, Ines/Q-6535-2016

  '
times-cited: '15'
title: Barriers along the care cascade of HIV-infected men in a large urban center
  of Brazil
type: Article
unique-id: WOS:000368505200007
usage-count-last-180-days: '0'
usage-count-since-2013: '6'
volume: '28'
web-of-science-categories: 'Health Policy \& Services; Public, Environmental \& Occupational
  Health;

  Psychology, Multidisciplinary; Respiratory System; Social Sciences,

  Biomedical'
year: '2016'