Multilevel factors influencing HIV care and management in the Deep South: insights from HIV care professionals

The United States Deep South bears a disproportionate HIV burden, with low rates of retention in care and viral suppression among people living with HIV (PWH). Factors influencing HIV care engagement can be understood through the modified social ecological model (MSEM), which comprises five interconnected layers: individual, network, community, policy, and HIV epidemic stage. We interviewed thirty HIV care professionals from Alabama, Mississippi, and Louisiana to identify optimal, culturally relevant approaches for engaging PWH in care. Using MSEM for qualitative analysis, we identified salient factors affecting HIV care engagement including spirituality, stigma, medical trust, wellness, risk perception, structural barriers, technology, social and sexual networks, clinic characteristics, HIV awareness, access to education, testing, PrEP, social assistance, and federal, statewide, and insurance policies. Our findings outline areas for organizational, community-level, and policy changes to improve health outcomes including implementing holistic care in HIV clinics that addresses socioeconomic barriers through public funding mechanisms, expanding sex education beyond abstinence-only curricula, promoting HIV education and testing within faith-based settings, and ensuring Medicaid coverage of low-income PWH to support medication adherence and viral suppression. By centering insights of those delivering and coordinating care, this study provides practical guidance for guiding interventions toward national goals.