HIV and Ongoing Methamphetamine Use: A Grounded Theory of Engagement in HIV Care from the BASE Study

The co-occurrence of HIV and substance use disorders (SUDs) presents significant challenges for engagement in HIV care, with an estimated 48% of people living with HIV (PLWH) also having an SUD. This qualitative substudy of the BASE clinical trial employed constructivist grounded theory methodology to understand factors influencing engagement in HIV care among PLWH with ongoing SUDs. Fifteen participants who completed the BASE study participated in semistructured interviews about their experiences with HIV care engagement. Median age was 40 (range 21-61), 80% male sex, 27% Black, and 27% Hispanic. The analysis resulted in a model centered on three intrapersonal factors: motivation for care, capacity to remember care behaviors, and ability to engage in care. These factors existed within a broader context of stigma, ongoing substance use, and financial insecurity, which created significant barriers to care engagement. However, participants identified interpersonal relationships and clinic interventions as important facilitators that helped them maintain engagement in care. The study provides novel insights by developing a model directly from patient perspectives, conceptualizing engagement as existing on a spectrum, and identifying varied ways participants accessed motivation through relationships. These findings could inform the development of more effective interventions that account for the specific needs of people living with both HIV and SUDs.