Quality of care for Black and Latina women living with HIV in the U.S.: a qualitative study

Int J Equity Health. 2020 Jul 6;19(1):115. doi: 10.1186/s12939-020-01230-3.


Background: Ending the HIV epidemic requires that women living with HIV (WLWH) have access to structurally competent HIV-related and other health care. WLWH may not regularly engage in care due to inadequate quality; however, women's perspectives on the quality of care they receive are understudied.

Methods: We conducted 12 focus groups and three in-depth interviews with Black (90%) and Latina (11%) WLWH enrolled in the Women's Interagency HIV Study in Atlanta, GA, Birmingham, AL, Brooklyn, NY, Chapel Hill, NC, Chicago, IL, and Jackson, MS from November 2017 to May 2018 (n = 92). We used a semi-structured format to facilitate discussions about satisfaction and dissatisfaction with health care engagement experiences, and suggestions for improvement, which were audio-recorded, transcribed, and coded using thematic analysis.

Results: Themes emerged related to women's health care satisfaction or dissatisfaction at the provider, clinic, and systems levels and across Institute of Medicine-defined quality of care domains (effectiveness, efficiency, equity, patient-centeredness, safety and timeliness). Women's degree of care satisfaction was driven by: 1) knowledge-based care resulting in desired outcomes (effectiveness); 2) coordination, continuity and necessity of care (efficiency); 3) perceived disparities in care (equity); 4) care delivery characterized by compassion, nonjudgment, accommodation, and autonomous decision-making (patient-centeredness); 5) attention to avoiding side effects and over-medicalization (safety); and 6) limited wait time (timeliness).

Conclusions: Quality of care represents a key changeable lever affecting engage in care among WLWH. The communities most proximally affected by HIV should be key stakeholders in HIV-related quality assurance. Findings highlight aspects of the health care experience valued by WLWH, and potential participatory, patient-driven avenues for improvement.

Keywords: African American; Black; Engagement in care; HIV/AIDS; Hispanic; Patient satisfaction; Qualitative; Quality of health care; Women living with HIV.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Attitude*
  • Black or African American*
  • Consumer Behavior*
  • Female
  • Focus Groups
  • HIV Infections / ethnology*
  • HIV Infections / therapy
  • Health Equity*
  • Hispanic or Latino*
  • Humans
  • Middle Aged
  • Midwestern United States
  • New England
  • Patient Participation
  • Patient Safety
  • Qualitative Research
  • Quality of Health Care*
  • Southeastern United States
  • Women's Health