Disparities in Retention in Care Among Adults Living with HIV/AIDS: A Systematic Review

Anderson, Ashley; Higgins, Christine M; Haardörfer, Regine; Holstad, Marcia McDonnell; Nguyen, Minh Ly; Waldrop‐Valverde, Drenna

doi:10.1007/s10461-019-02679-2

Cited by 39 publications

(37 citation statements)

References 39 publications

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“…Many factors affecting retention in care have been addressed in the literature. Facilitating transportation and access to care, increasing the quality of patient-professional relationship, community-based accompaniment, decreasing health disparities, and stigma increase retention in care [ 43–45 ]. However, the impact on retention in care of IMAPs, which assess patients’ complex and multiple needs, has rarely been investigated.…”

Section: Discussionmentioning

confidence: 99%

An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort

Kamal

Glass

Doco‐Lecompte

et al. 2020

Open Forum Infectious Diseases

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Background This study tested a theory-based adherence enhancing intervention, the “Interprofessional Medication Adherence Program” (IMAP) to increase HIV retention in care. Methods We retrospectively compared our intervention center (IG) with a standard of care center (CG) both participating in the Swiss HIV cohort Study (SHCS) between 2004 and 2012. Endpoints were defined as > 6-month and >12-month gaps in care for intervals of care longer than 6- and 12-month without any blood draw. Inverse probability of treatment weights (IPTW) was used to adjust for differences between patients at the two centers. Viral failure was defined as RNA≥50 copies/ml after 24+ weeks on antiretrovirals. Results The IG included 451 patients, CG 311. In the IG, 179 (40%) took part in the IMAP for a median of 27 months (IQR:12-45). Gaps in care of ≥6 months were significantly more likely to happen in the CG vs. IG (74.6% vs. 57%, P<0.001). The median time until the first treatment gap was longer in the IG vs. CG (120 vs 84 weeks, P<0.001). Gaps in care of ≥ 12 months evaluated in 709 (93%) patients were significantly more likely to occur in the CG compared to the IG (22.6% vs. 12.5%, P<0.001). The rate of viral failure was significantly lower in the IG (8.3% vs. 15.1%, P=0.003). Conclusions This study, in a real-world setting, tends to show the effectiveness of the IMAP to reduce 6- and 12-month gaps in follow-up among people with HIV. These results should be confirmed by studies in other settings.

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Section: Discussionmentioning

confidence: 99%

An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort

Kamal

Glass

Doco‐Lecompte

et al. 2020

Open Forum Infectious Diseases

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“…Multiple systematic reviews conducted in recent years have documented multidimensional racial inequalities in health care use, medical treatment, and quality of care in minority populations, particularly the non-Hispanic Black population in the United States. These systematic reviews documented a variety of racial disparities including but not limited to delay in initiation or receipt of cancer screening and inadequate treatment [55][56][57] ; access for and management of Parkinson disease 58 ; treatments for dementia 59 ; use of neurology care 60 ; end-of-life, palliative, and hospice care [61][62][63] ; home health care disparities 64 ; care quality, treatment, and outcomes of cardiovascular diseases 65,66,76 ; acute and chronic pain management 67,68 ; HIV care 69 ; trauma mortality 70 ; complications and/ or mortality following orthopedic procedures 71,72 ; and children's health and health care. [73][74][75] These structural and systematic racial disparities in the United States have led to poor health outcomes, worse health status, and low quality of care for minority groups, especially non-Hispanic Black and Hispanic populations.…”

Section: Findings In Contextmentioning

confidence: 99%

Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults

2021

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“…Race/ethnic disparities in HIV care are a longstanding concern in the HIV treatment eld. It was hoped that disparities would be at least partially mitigated post-ACA [4,37], although recent data indicate that non-whites continue to have worse HIV care outcomes across multiple health care settings [38][39][40]. It is possible that factors associated with race/ethnicity and worse HIV outcomes but not measured in our study, such as health literacy [41] and variability in use of electronic provider communication tools [42,43] could have contributed to these differences.…”

Section: Discussionmentioning

confidence: 83%

Health care utilization and HIV clinical outcomes following Affordable Care Act implementation in California: A longitudinal study

Satre¹,

Parthasarathy²,

Silverberg³

et al. 2020

Preprint

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Background: The Affordable Care Act (ACA) increased insurance coverage for people with HIV (PWH) in the United States, yet post-ACA health care utilization and HIV outcomes have rarely been examined. Methods: Among PWH newly enrolled in an integrated health care system (Kaiser Permanente Northern California) in 2014 (N=880), we examined use of health care and modeled associations between enrollment mechanisms (enrolled in a Qualified Health Plan through the California Exchange vs. other sources), deductibles (none, $1-$999 and >= $1000), receipt of benefits from the California AIDS Drug Assistance Program (ADAP), demographic factors, and three-year patterns of health service utilization (primary care, psychiatry, substance treatment, emergency, inpatient) and HIV outcomes (CD4 counts, viral suppression). Results: Health care use was greatest immediately after enrollment and decreased over three years. Those with high deductibles were less likely to use primary care (OR=0.64, 95% CI=0.49 - 0.83, p < 0.001) or psychiatry OR=0.58, 95% CI=0.36, 0.93, p=0.02) than those with low or no deductibles. Enrollment via the Exchange was associated with fewer psychiatry visits (rate ratio [RR]=0.38, 95% CI=0.17 - 0.83; p=0.02), but ADAP was positively associated with number of psychiatry visits (RR=2.22, 95% CI=1.22 – 4.05 p=0.01). There was no association between enrollment mechanism or deductibles and HIV outcomes, but ADAP enrollment was associated with viral suppression (OR=2.23, 95% CI=1.35 - 3.68, p<0.001). Non-white PWH were less likely to be virally suppressed, (OR=0.47, 95% CI= 0.31 - 0.71, p< 0.001). Conclusions: In this sample of PWH drawn from an integrated health care system in California, findings suggest that enrollment via the Exchange and higher deductibles were negatively associated with some aspects of service utilization but did not impact HIV outcomes; support from ADAP appeared to help patients achieve viral suppression; ethnic disparities remain important to address in post-ACA health services for PWH even among those with access to insurance coverage.

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Disparities in Retention in Care Among Adults Living with HIV/AIDS: A Systematic Review

Cited by 39 publications

References 39 publications

An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort

An Adherence-Enhancing Program Increases Retention in Care in the Swiss HIV Cohort

Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults

Health care utilization and HIV clinical outcomes following Affordable Care Act implementation in California: A longitudinal study

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