Abstract
Previous models examined the cause-and-effect relationships of select constructs affecting HIV care and treatment adherence,1,2 which may not reflect the complex, multidimensional nature of persons with HIV’s (PWH) care adherence in real-world settings, especially in the Philippines, with one of the highest rates of HIV and AIDS cases globally.3 The HIV Care Adherence Journey (HCAJ) Model4 presents four domains on PWH’s care adherence in relation to individual, social, and healthcare system characteristics. The present study aimed to validate this model by describing and comparing PWH’s perceived care adherence journey and adherence behaviors, and examining patterns in PWH’s experiences related to care adherence.
The study employed a convergent mixed-methods design. The quantitative method involved a cross-sectional survey with a quota sample of 361 PWH who completed questionnaires about their sociodemographic, clinical, treatment-related, and adherence behavior characteristics and the HCAJ Instrument.5 The qualitative method involved semi-structured interviews on the care adherence journey with a maximum variation sample of 24 PWH. Quantitative analysis used descriptive and comparative statistics, whereas qualitative analysis utilized thematic analysis. A joint display table was used to compare and integrate qualitative and quantitative findings.
High levels of scores in the HCAJ Instrument and adherence to HIV care were observed among survey participants. By number of years living with HIV, the Kruskal-Wallis test showed significant differences in clinic visit adherence in the past 12 months (p = .002), viral load testing within the 6-12 months (p < .001), viral load status (p < .001), and CD4 count level (p < .001). Significant differences were found in participants’ scores on the accessibility (p < .001), delivery (p < .001), and collaboration (p < .001) subscales of the HCAJ Instrument. Thematic analysis showed three major phases that PWH go through in mastering living with HIV. The integration of findings highlights the significance of the individual journey of living with HIV.
The HCAJ Model was revised and expanded, and nurses and other care providers can use this model to anticipate shifting needs and adjust care plans as individuals transition through phases of living with HIV. Findings suggest that patient care services should prioritize integrated service delivery and community-embedded resources to address structural barriers across the journey.
Notes
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References:
1. Mirzaei-Alavijeh M, Rahimi F, Hamzeh B, Mansouri F, Shoukohi N, Jalilian F. Insights into medication adherence among HIV-positive patients: the integrated change model. AIDS Res Ther. 2025;22(1):66. Published 2025 Jul 9. doi:10.1186/s12981-025-00763-3
2. Whiteley LB, Olsen EM, Haubrick KK, Odoom E, Tarantino N, Brown LK. A review of interventions to enhance HIV medication adherence. Curr HIV/AIDS Rep. 2021;18(5):443-457. doi:10.1007/s11904-021-00568-9
3. Joint United Nations Programme on HIV/AIDS. The urgency now: AIDS at a crossroads. Joint United Nations Programme on HIV/AIDS. Accessed November 15, 2025. https://www.unaids.org/sites/default/files/media_asset/2024-unaids-global-aids-update_en.pdf
4. De Torres RQ, Operario D. Characterizing the "HIV Care Adherence Journey" for Persons with HIV in the Philippines: Conceptual foundation for person-centered intervention. J Assoc Nurses AIDS Care. 2024;35(4):325-338. doi:10.1097/JNC.0000000000000461
5. De Torres RQ, Palatino M, Operario D. Development and psychometric testing of the HIV Care Adherence Journey Instrument for persons with HIV in the Philippines: A methodological study. J Assoc Nurses AIDS Care. 2025. doi:10.1097/JNC.0000000000000565
Sigma Membership
Alpha Alpha Phi
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Cross-Sectional
Research Approach
Mixed/Multi Method Research
Keywords:
Theory, Health Equity or Social Determinants of Health, Sustainable Development Goals, HIV Infections, HIV-Positive Persons, Instrument Validation, Philippines
Recommended Citation
De Torres, Ryan Quintero; Ngaya-an, Floreliz V.; Operario, Don; Cu-Uvin, Susan; Parial, Laurence Lloyd; and Tuazon, Josefina A., "Validation and Expansion of the HIV Care Adherence Journey Model: A Mixed Methods Research" (2026). International Nursing Research Congress (INRC). 245.
https://www.sigmarepository.org/inrc/2026/presentations_2026/245
Conference Name
37th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Toronto, Ontario, Canada
Conference Year
2026
Rights Holder
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Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2026-08-29
Validation and Expansion of the HIV Care Adherence Journey Model: A Mixed Methods Research
Toronto, Ontario, Canada
Previous models examined the cause-and-effect relationships of select constructs affecting HIV care and treatment adherence,1,2 which may not reflect the complex, multidimensional nature of persons with HIV’s (PWH) care adherence in real-world settings, especially in the Philippines, with one of the highest rates of HIV and AIDS cases globally.3 The HIV Care Adherence Journey (HCAJ) Model4 presents four domains on PWH’s care adherence in relation to individual, social, and healthcare system characteristics. The present study aimed to validate this model by describing and comparing PWH’s perceived care adherence journey and adherence behaviors, and examining patterns in PWH’s experiences related to care adherence.
The study employed a convergent mixed-methods design. The quantitative method involved a cross-sectional survey with a quota sample of 361 PWH who completed questionnaires about their sociodemographic, clinical, treatment-related, and adherence behavior characteristics and the HCAJ Instrument.5 The qualitative method involved semi-structured interviews on the care adherence journey with a maximum variation sample of 24 PWH. Quantitative analysis used descriptive and comparative statistics, whereas qualitative analysis utilized thematic analysis. A joint display table was used to compare and integrate qualitative and quantitative findings.
High levels of scores in the HCAJ Instrument and adherence to HIV care were observed among survey participants. By number of years living with HIV, the Kruskal-Wallis test showed significant differences in clinic visit adherence in the past 12 months (p = .002), viral load testing within the 6-12 months (p < .001), viral load status (p < .001), and CD4 count level (p < .001). Significant differences were found in participants’ scores on the accessibility (p < .001), delivery (p < .001), and collaboration (p < .001) subscales of the HCAJ Instrument. Thematic analysis showed three major phases that PWH go through in mastering living with HIV. The integration of findings highlights the significance of the individual journey of living with HIV.
The HCAJ Model was revised and expanded, and nurses and other care providers can use this model to anticipate shifting needs and adjust care plans as individuals transition through phases of living with HIV. Findings suggest that patient care services should prioritize integrated service delivery and community-embedded resources to address structural barriers across the journey.
Description
A mixed-methods study was implemented to validate and expand the HIV Care Adherence Journey Model using an online survey and semi-structured interviews among PWH. Integration of findings helped revise the HIV Care Adherence Journey Model to holistically highlight the significance of the unique individual journey of living with HIV.