Healthcare Empowerment and HIV Viral Control: Mediating Roles of Adherence and Retention in Care

Wilson, Tracey E.; Kay, Emma Sophia; Turan, Bülent; Johnson, Mallory O.; Kempf, Mirjam Colette; Turan, Janet M.; Cohen, Mardge H.; Adimora, Adaora A.; Pereyra, Margaret; Golub, Elizabeth T.; Goparaju, Lakshmi; Murchison, Lynn; Wingood, Gina M.; Metsch, Lisa R.

doi:10.1016/j.amepre.2018.02.012

Cited by 18 publications

(27 citation statements)

References 74 publications

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“…Previous studies provide evidence for the validity of self-reported missed visits, which showed associations with viral suppression and mortality. 22–26 For the current analyses, sub-optimal visit adherence was defined as missing at least one HIV visit in the last two years in order to increase reliability of the measure as was done in previous research 27 (0 = made all visits in the last two years; 1 = missed one or more visits in the last two years). The data also include perceived frequency of provider demand for visits: “How often do your HIV providers want to see you for your regular HIV care?” (dichotomized as less than three times a year vs. three times a year or more frequently).…”

Section: Methodsmentioning

confidence: 99%

Internal Working Models of Attachment Relationships and HIV Outcomes Among Women Living With HIV

Turan¹,

Crockett²,

Kempf

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Treatment adherence and viral suppression remain sub-optimal in the US. Attachment insecurity may be one understudied factor affecting adherence. According to attachment theory, people develop generalized internal working models of interpersonal relationships, which shape their perceptions of the availability of others at times of stress and how they handle stressors as an individual. Two dimensions of attachment insecurity are attachment-related avoidance (avoidance of intimacy with others and avoidance of negative emotions) and attachment-related anxiety (feeling unable to deal with stressors without others’ help). For people living with chronic stressful health conditions that require life-long self-management, attachment-related avoidance and attachment-related anxiety may diminish the ability to cope with stressors as an individual leading to negative health outcomes. Methods: We examined cross-sectional associations of the two attachment-related insecurity dimensions with ART adherence, HIV visit adherence, CD4 cell counts, and viral suppression. Survey and clinical data from 453 women living with HIV in four US cities were analyzed controlling for age, education, income, time on ART, illicit drug use, and race. Results: Attachment-related avoidance was the only unique predictor of sub-optimal ART adherence, viral failure, and low CD4 count, and attachment-related anxiety was the only unique predictor of missed HIV care visits. These effects were over and above the effects of all covariates. ART adherence mediated the association of attachment-related avoidance with both viral failure and low CD4 counts. Conclusions: Interventions may need to focus on the vulnerable sub-population with high attachment insecurity and incorporate existing strategies that address insecure attachment models.

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Section: Methodsmentioning

confidence: 99%

Internal Working Models of Attachment Relationships and HIV Outcomes Among Women Living With HIV

Turan¹,

Crockett²,

Kempf

et al. 2019

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

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“…The HCE model enables the organization, investigation, and intervention upon factors that contribute to optimal health outcomes and posits that vulnerable populations will experience improved health outcomes when they are informed, committed, collaborative, and engaged in their healthcare, and when they are able to tolerate uncertainty of future health outcomes. Studies have provided support for the HCE framework in explaining antiretroviral treatment (ART) uptake, adherence, and resulting viral suppression among non-transgender people living with HIV [16,[18][19][20]. The integration of the Model of Gender Affirmation with the Healthcare Empowerment Model results in a powerful and innovative conceptual framework for exploring intervention-amenable factors that affect health outcomes from a perspective that is grounded in the unique cultural context of transgender women living with HIV.…”

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confidence: 99%

Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV

et al. 2019

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Transgender women of color are disproportionately impacted by HIV, poor health outcomes, and transgender-related discrimination (TD). We tested the Model of Gender Affirmation (GA) to identify intervention-amenable targets to enhance viral suppression (VS) using data from 858 transgender women of color living with HIV (49% Latina, 42% Black; 36% virally suppressed) in a serial mediation model. Global fit statistics demonstrated good model fit; statistically significant (p ≤ 0.05) direct pathways were between TD and GA, GA and healthcare empowerment (HCE), and HCE and VS. Significant indirect pathways were from TD to VS via GA and HCE (p = 0.036) and GA to VS via HCE (p = 0.028). Gender affirmation and healthcare empowerment significantly and fully mediated the total effect of transgender-related discrimination on viral suppression. These data provide empirical evidence for the Model of Gender Affirmation. Interventions that boost gender affirmation and healthcare empowerment may improve viral suppression among transgender women of color living with HIV.

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“…Second, all measures were self-reported, which could result in measurement bias. Though, a previous WIHS study found that there was high level of agreement between care receipt measured via self-report and medical records among a small subset of women who had both measures [50]. Third, the measures used to assess mental health and socioeconomic position may not have comprehensively captured participants' mental health and socioeconomic position [51].…”

Section: Discussionmentioning

confidence: 97%

The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV

et al. 2019

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contains supplementary material, which is available to authorized users. Conflict of interest The authors declare that they have no conflict of interest. Ethical Approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed Consent Informed consent was obtained from all individual participants included in the study. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Healthcare Empowerment and HIV Viral Control: Mediating Roles of Adherence and Retention in Care

Abstract: The Informed Collaboration Committed Engagement healthcare empowerment component is a promising pathway through which to promote engagement in care among women living with HIV.

Cited by 18 publications

References 74 publications

Internal Working Models of Attachment Relationships and HIV Outcomes Among Women Living With HIV

Internal Working Models of Attachment Relationships and HIV Outcomes Among Women Living With HIV

Evidence for the Model of Gender Affirmation: The Role of Gender Affirmation and Healthcare Empowerment in Viral Suppression Among Transgender Women of Color Living with HIV

The Relationship Between Discrimination and Missed HIV Care Appointments Among Women Living with HIV

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