How Should We Organize Care for Patients With Human Immunodeficiency Virus and Comorbidities? A Multisite Qualitative Study of Human Immunodeficiency Virus Care in the United States Department of Veterans Affairs.

Background: With human immunodeficiency virus (HIV) now managed as a chronic disease, health care has had to change and expand to include management of other critical comorbidities. We sought to understand how variation in the organization, structure and processes of HIV and comorbidity care, based on patient-centered medical home (PCMH) principles, was related to care quality for Veterans with HIV.

Research Design: Qualitative site visits were conducted at a purposive sample of 8 Department of Veterans Affairs Medical Centers, varying in care quality and outcomes for HIV and common comorbidities.

Roadblocks to PrEP: What Medical Records Reveal About Access to HIV Pre-exposure Prophylaxis.

Background: Pre-exposure prophylaxis (PrEP) has been shown to be efficacious in preventing HIV; however, its uptake remains modest. Given that there are fewer cost barriers to receiving PrEP within VHA than via commercial insurance, VHA represents an ideal setting in which to study other barriers that may impact patients seeking PrEP.

Objective: We sought to understand potential barriers to obtaining PrEP within the Veterans Health Administration (VHA) through examination of documentation in electronic medical records.

Understanding the Context of High- and Low-Testosterone Prescribing Facilities in the Veterans Health Administration (VHA): a Qualitative Study.

Background: Inappropriate testosterone use and variations in testosterone prescribing patterns exist in the Veterans Health Administration (VHA) despite the presence of clinical guidelines.

Objective: We examined system and clinician factors that contribute to patterns of potentially inappropriate testosterone prescribing in VHA.

Design: Qualitative study using a positive deviance approach to understand practice variation in high- and low-testosterone prescribing sites.

Experiences with interferon-free hepatitis C therapies: addressing barriers to adherence and optimizing treatment outcomes.

Background: Millions of Americans are living with hepatitis C, the leading cause of liver disease in the United States. Medication treatment can cure hepatitis C. We sought to understand factors that contribute to hepatitis C treatment completion from the perspectives of patients and providers.

The moral discourse of HIV providers within their organizational context: An ethnographic case study.

Objective: Providers make judgments to inform treatment planning, especially when adherence is crucial, as in HIV. We examined the extent these judgments may become intertwined with moral ones, extraneous to patient care, and how these in turn are situated within specific organizational contexts.

Methods: Our ethnographic case study included interviews and observations.

Treatment experiences among LGBT veterans with discrimination-based trauma exposure: A pilot study.

Past research suggests that rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) are elevated among lesbian, gay, bisexual, and transgender (LGBT) veterans compared to heterosexual and cisgender veterans. Given higher rates of trauma exposure and PTSD, and the culture associated with the Department of Defense's history of policies excluding LGBT people, it is important to understand if LGBT veterans are seeking PTSD treatment following discrimination-based traumatic events, where they seek care, and if they are satisfied with treatment. This study aimed to describe the experiences of discrimination-based trauma-exposed LGBT veterans' (n = 47) experiences with PTSD treatment, including location of treatment (Veterans Health Administration [VHA] versus non-VHA) and satisfaction with care.

Use of testosterone in men infected with human immunodeficiency virus in the veterans healthcare system.

Testosterone supplementation has been widely used in those infected with human immunodeficiency virus (HIV) for hypogonadism, and wasting. But with effective antiretroviral therapy and increasing recognition of atherosclerotic disease and adults infected with HIV, the risks of inappropriate testosterone use in HIV-infected patients are far better recognized than previously. Testosterone use has expanded among U.

Medication Adherence in a Nationwide Cohort of Veterans Initiating Pre-exposure Prophylaxis (PrEP) to Prevent HIV Infection.

Background: Current guidelines for pre-exposure prophylaxis (PrEP) to prevent HIV infection call for long-term, daily use of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). Little is known about long-term adherence with TDF/FTC prescribed for PrEP in routine clinical practice.

Setting: Veterans Health Administration (VHA) clinics.

"Where's My Choice?" An Examination of Veteran and Provider Experiences With Hepatitis C Treatment Through the Veteran Affairs Choice Program.

Background: The Department of Veterans Affairs (VA) is the country's largest provider for chronic hepatitis C virus (HCV) infection. The VA created the Choice Program, which allows eligible veterans to seek care from community providers, who are reimbursed by the VA.

Objectives: This study aimed to examine perspectives and experiences with the VA Choice Program among veteran patients and their HCV providers.

Racial Disparities in HIV Care Extend to Common Comorbidities: Implications for Implementation of Interventions to Reduce Disparities in HIV Care.

Background: Prior studies have described racial disparities in the quality of care for persons with HIV infection, but it is unknown if these disparities extend to common comorbid conditions. To inform implementation of interventions to reduce disparities in HIV care, we examined racial variation in a set of quality measures for common comorbid conditions among Veterans in care for HIV in the United States.

Method: The cohort included 23,974 Veterans in care for HIV in 2013 (53.

Poverty and mental health practice: within and beyond the 50-minute hour.

Despite the high and increasing prevalence of poverty in the United States, psychologists and allied professionals have done little to develop mental health interventions that are tailored to the specific sociocultural experiences of low-income families. In this article, we describe the sociocultural stressors that accompany the material deprivations of poverty, and the mental health difficulties to which they often give rise. Next, we outline the psychosocial and class-related issues surrounding low-income adults' access to and use of mental health services and suggest a conceptual framework to guide the modification of mental health practice to better accommodate poor peoples' complex needs.