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Purpose: Little is known about factors affecting HIV care engagement and retention among rural people with HIV (PWH) in the South. About half of PWH in Arkansas reside in rural areas. The purpose of this study was to explore factors affecting engagement and retention in HIV care among PWH in rural areas of Arkansas. Methods: We conducted an exploratory qualitative study in 2020 and completed individual interviews (N = 11) with PWH in rural counties in Arkansas. Findings: Content analysis revealed the following themes: (1) Barriers to HIV care included long distances to the nearest HIV clinic and transportation issues along with anticipating and/or experiencing HIV‐related stigma; (2) facilitators of HIV care included having a helpful HIV care provider and Ryan White case manager and a social support network that aided them in prioritizing their own health; (3) participants had the most favorable reactions to Ryan White case management, peer navigators, and telemedicine for HIV treatment/care; and (4) participants demonstrated resilience overcoming various obstacles as they worked toward being healthy mentally and physically while living with HIV. Conclusion: Interventions need to address multilevel factors, including hiring PWH as peer navigators and/or caseworkers and offering HIV care via telemedicine, to improve HIV care engagement and retention among rural populations. [ABSTRACT FROM AUTHOR]

Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release. [ABSTRACT FROM AUTHOR]