Recorded presentation

Danielle Greene, DrPH, Mary K. Irvine, MPH, Saba Jearld, MPH, Nancy L VanDevanter, DrPH, Cheryl Merzel, DrPH, and Emily A. Nishi, MPA. Center for Applied Public Health, Mailman School of Public Health, Columbia University, 722 W. 168th St, New York, NY 10032, 212-342-0153, dg134@columbia.edu

Background: Environment can have a powerful impact on the healthcare experience. While the principal interaction during a clinic visit is between the patient and physician, interactions with other staff, and other patients also occur. In the family-centered model of pediatric HIV care, caregivers, siblings, and partners may also participate. However, little is known about caregivers' perceptions of the clinic environment and the affect it has on their ability to remain enrolled in care and adhere to their children's antiretroviral regimens. Methods: Qualitative interviews were conducted with a purposive sample of 30 caregivers recruited from Ryan White CARE Act Title IV clinics. Respondents included biological, kinship and non-kinship-adoptive caregivers between the ages of 29 and 73; 90% were female, 60% African-American, and 40% Latino. Interviews explored coordinative, informational, environmental, and interpersonal aspects of care. All sessions were audio-taped, transcribed, coded independently by two researchers, and analyzed in ATLAS.ti. Results: Respondents commented on four components of clinic atmosphere. These were provider attitude, interactions with other caregivers, child to child relationships, and the facility itself. The interpersonal aspects of the atmosphere made attending clinic less burdensome for caregivers, while features of the physical facility were important to children. Conclusions: Caregivers found camaraderie and social support among the other caregivers attending clinic appointments. Normalized socialization occurred for children who found peers who also took medication in the clinics. Becoming aware through the clinic of other families in similar situations was beneficial to both caregivers and children regarding HIV medication adherence.

Learning Objectives:

• To recognize four different facets of the clinic atmosphere as experienced by caregivers of children living with HIV/AIDS.
• To describe the aspects of the clinic atmosphere that can impact on adherence to healthcare appointments and to HIV medications in a pediatric HIV care setting.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation