Factors Associated with Engaging Socially Marginalized HIV-Positive Persons in Primary Care

Access to sustained HIV medical care is critical to achieving viral suppression. However, a variety of factors may impede or facilitate retention in care or becoming virally suppressed. Though retention and suppression are often treated separately, this study examined both in a cohort of 921 HIV + women of color who participated in eight demonstration programs across the US. For women who met the inclusion criteria, 83% (n = 587) were retained and 73% (n = 357) were virally suppressed. Average age of women retained was 40.9, and 41.9 for those virally suppressed. The majority were African American/Black or Hispanic/Latina, single, and had no children less than 18 years of age, had health insurance, a high school degree or higher, were stably housed, and unemployed. Some factors associated with retention in care were indecision about seeking HIV medical care (AOR = 0.42) and having children under the age of 18 (AOR = 0.59). Some factors associated with being virally suppressed were living with others (AOR = 0.58), current substance abuse (AOR = 0.38), and fair/poor health (AOR = 0.40). The findings suggest different processes and social mechanisms may influence retention and viral suppression. Interventions seeking to improve retention in care may require tailored program components and strategies that focus on improving viral suppression.

Section: Discussionmentioning

confidence: 99%

Factors Associated with Retention and Viral Suppression Among a Cohort of HIV+ Women of Color

Blank

Fletcher

Verdecias

et al. 2015

“…[40][41][42] Some studies using different age ranges for analysis found no difference in linkage in younger adults. 35,[43][44][45] However, combining published data from these studies (Table 1), we estimate that 62% of newly diagnosed HIV-infected adolescents and young adults in the United States link to care within the first 6-12 months.…”

Section: Linkage To Carementioning

confidence: 97%

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

Zanoni

Mayer²

2014

359

315

Little is known about how adolescents and young adults contribute to the declines in the cascade of care from HIV-1 diagnosis to viral suppression. We reviewed published literature from the Unites States reporting primary data for youth (13-29 years of age) at each stage of the HIV cascade of care. Approximately 41% of HIVinfected youth in the United States are aware of their diagnosis, while only 62% of those diagnosed engage medical care within 12 months of diagnosis. Of the youth who initiate antiretroviral therapy, only 54% achieve viral suppression and a further 57% are not retained in care. We estimate less than 6% of HIV-infected youth in the United States remain virally suppressed. We explore the cascade of care from HIV diagnosis through viral suppression for HIV-infected adolescents and young adults in the United States to highlight areas for improvement in the poor engagement of the infected youth population.

“…11 For example, suboptimal HIV health care utilization patterns are associated with racial=ethnic minority status, 9,[15][16][17][18] economic and health insurance difficulties, [19][20][21][22] engaging in illicit drug or alcohol use, [23][24][25][26][27] having unstable housing, 28,29 and difficulty developing positive relationships with a primary care provider. [30][31][32][33][34][35][36][37][38] Because barriers to health care utilization vary by population, it is crucial for providers and interventionists to identify key barriers that are specific to the disadvantaged populations that they target.…”

Section: Introductionmentioning

confidence: 99%

Gender Disparities in HIV Health Care Utilization among the Severely Disadvantaged: Can We Determine the Reasons?

Sohler

Cunningham

2009

Data repeatedly demonstrate that HIV-infected people who regularly utilize primary health care services are more likely to have access to lifesaving treatments (including antiretroviral medications); have better indicators of health status; survive longer; and use acute care services far less. Women tend to have poorer HIV outcomes than men, which is likely due to gender disparities in optimal utilization of HIV primary care services. To understand the relationship between gender and the HIV health care system, we collected interview and medical record data between August 12, 2004 and June 7, 2005 from 414 severely marginalized, HIV-infected people in New York City and examined whether gender-related disparities in HIV health care utilization existed, and, if so, whether these patterns were explained by patient sociodemographic=behavioral characteristics and=or attitudes toward the health care system and providers. Women were significantly less likely to have optimal HIV health care services utilization, including lower use of HIV primary care services (odds ratio [OR] ¼ 0.56, 95% confidence interval [CI] ¼ 0.35, 0.90) and greater use of the emergency department (OR ¼ 2.13, 95% CI ¼ 1.31, 3.46). Although we identified several factors associated with suboptimal HIV health care services utilization patterns in addition to female gender (low education, insurance status, mistrust of the health care system, and poor trust in health care providers), we were unable to identify factors that explained the observed gender disparities. We conclude that gender disparities in HIV health care utilization are due to a complex array of factors, which require more qualitative and quantitative research attention. Development of intervention strategies that specifically target severely disadvantaged women's HIV health care utilization is in great need.