Rence aids (e.g. pill boxes, text reminders) [31?3]. Successful interventions to improve retention in HIV care have required more complex and intensive efforts to decrease unmet needs, decrease structural barriers and reduce substance abuse [34]. Given the suboptimal state of retention in HIV care and adherence to HAART, it is critical to identify additional modifiable drivers to inform evidence-based interventions to optimize HIV care. Patient satisfaction represents an 114311-32-9 site innovative focus for retention and adherence intervention efforts. Its innovation derives from applying the business model of customer satisfaction to improve patient adherence to care. Additionally, interventions to improve patient satisfaction with the overall care experience are not directly dependent on efforts to explicitly change patient behavior. Patient satisfaction reflects the patient’s perception of the entire care process, and improving satisfaction metrics lies within the power of a clinic or institution. Research indicates that provider and organizational factors play a large role in how patients evaluate their provider and overallclinic care [8,35]. Several empirical studies have shown that training in patient-centered communication and audit feedback can help providers improve communication skills in ways that increase patient satisfaction [36,37]. Furthermore, organizational factors like increasing the time allowed for provider visits and ensuring continuity of care with the same provider can increase patients’ satisfaction with their provider and overall care [38?0]. Continued progress in studying patient satisfaction requires not only additional evaluation of its effects on health outcomes, but also 
developing an understanding of the particular mechanisms or processes through which beneficial results are achieved. The development of successful interventions to improve retention in HIV care and adherence to HAART requires a 115103-85-0 better understanding of how patient satisfaction impacts those constructs. The exact mechanisms explaining the linkages between these constructs remain unclear. Additionally, it remains unclear which component or components of the care experience most strongly influence retention and adherence. Several studies, including a previous study based on this dataset, have reported that patients’ evaluation of their provider correlates the strongest with their overall satisfaction [35,41,42]. However, the provider characteristic most predictive of overall 15755315 patient satisfaction may differ from 
those that may affect clinical outcomes. For example, provider training in problem solving focused adherence counseling techniques, as proposed in Wilson et al. [43], may have more influence on adherence than providers’ interpersonal and general communication skills. Future research directions need to include prospective quantitative studies to: 1) better understand which component or components of the care experience are most predictive of overall patient satisfaction, medication adherence and retention in HIV care, 2) quantify how the strength of association changes over time as care progresses and what factors significantly influence those trends, and 3) establish causal direction. This study has several methodological strengths. Our practicebased model incorporates the business model of customer satisfaction with the clinical end point of HIV suppression. The study took place at 2 clinic sites. It primarily included a lowincome minority population,.Rence aids (e.g. pill boxes, text reminders) [31?3]. Successful interventions to improve retention in HIV care have required more complex and intensive efforts to decrease unmet needs, decrease structural barriers and reduce substance abuse [34]. Given the suboptimal state of retention in HIV care and adherence to HAART, it is critical to identify additional modifiable drivers to inform evidence-based interventions to optimize HIV care. Patient satisfaction represents an innovative focus for retention and adherence intervention efforts. Its innovation derives from applying the business model of customer satisfaction to improve patient adherence to care. Additionally, interventions to improve patient satisfaction with the overall care experience are not directly dependent on efforts to explicitly change patient behavior. Patient satisfaction reflects the patient’s perception of the entire care process, and improving satisfaction metrics lies within the power of a clinic or institution. Research indicates that provider and organizational factors play a large role in how patients evaluate their provider and overallclinic care [8,35]. Several empirical studies have shown that training in patient-centered communication and audit feedback can help providers improve communication skills in ways that increase patient satisfaction [36,37]. Furthermore, organizational factors like increasing the time allowed for provider visits and ensuring continuity of care with the same provider can increase patients’ satisfaction with their provider and overall care [38?0]. Continued progress in studying patient satisfaction requires not only additional evaluation of its effects on health outcomes, but also developing an understanding of the particular mechanisms or processes through which beneficial results are achieved. The development of successful interventions to improve retention in HIV care and adherence to HAART requires a better understanding of how patient satisfaction impacts those constructs. The exact mechanisms explaining the linkages between these constructs remain unclear. Additionally, it remains unclear which component or components of the care experience most strongly influence retention and adherence. Several studies, including a previous study based on this dataset, have reported that patients’ evaluation of their provider correlates the strongest with their overall satisfaction [35,41,42]. However, the provider characteristic most predictive of overall 15755315 patient satisfaction may differ from those that may affect clinical outcomes. For example, provider training in problem solving focused adherence counseling techniques, as proposed in Wilson et al. [43], may have more influence on adherence than providers’ interpersonal and general communication skills. Future research directions need to include prospective quantitative studies to: 1) better understand which component or components of the care experience are most predictive of overall patient satisfaction, medication adherence and retention in HIV care, 2) quantify how the strength of association changes over time as care progresses and what factors significantly influence those trends, and 3) establish causal direction. This study has several methodological strengths. Our practicebased model incorporates the business model of customer satisfaction with the clinical end point of HIV suppression. The study took place at 2 clinic sites. It primarily included a lowincome minority population,.
