The Boundary of HIV Care: Barriers and Facilitators to Care Engagement Among People with HIV in the United States

Padilla, Mabel; Carter, Brittani; Gutierrez, Mariana; Fagan, Jennifer

doi:10.1089/apc.2022.0062

Cited by 16 publications

(13 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…System-related facilitators included positive attributes of patient-provider relationships (eg, providers who are empathic, are nonjudgmental, engage patients in a conversation, and take time to listen) and flexible appointments (eg, scheduled soon after requested or offered outside traditional work hours). 31 Structural-level facilitators of care included transportation (eg, access to public and private transportation; having available public transportation routes close to home and health care facilities; and reducing, subsidizing, or eliminating the cost of transportation), health insurance (eg, reducing, subsidizing, or eliminating cost associated with seeking care), and financial help (eg, being employed and securing income is a precursor to seeking care). 31 If research suggests that PWH in care experience the same issues that those PWH who are of out of care report are barriers to engaging in care, then an argument can be made that those in care are susceptible or at risk of falling out of care if these issues are not addressed.…”

Section: Discussionmentioning

confidence: 99%

“…31 Structural-level facilitators of care included transportation (eg, access to public and private transportation; having available public transportation routes close to home and health care facilities; and reducing, subsidizing, or eliminating the cost of transportation), health insurance (eg, reducing, subsidizing, or eliminating cost associated with seeking care), and financial help (eg, being employed and securing income is a precursor to seeking care). 31 If research suggests that PWH in care experience the same issues that those PWH who are of out of care report are barriers to engaging in care, then an argument can be made that those in care are susceptible or at risk of falling out of care if these issues are not addressed. Black and Hispanic/Latina women in this study were "in care" with respect to taking ART, yet disparities in ART adherence and SVS were still evident and associated with structural-level factors such as transportation, health insurance, and financial need (ie, poverty).…”

Section: Discussionmentioning

confidence: 99%

“…Previous research suggests that the factors associated with racial/ethnic disparities in ART adherence and SVS observed in this study are also barriers to HIV care engagement reported by PWH not in care. 31 Padilla et al 31 examined qualitative data to understand barriers and facilitators to HIV care engagement among PWH who participated in the MMP from June 2018 to May 2019 and were not engaged in HIV care. Several system- and structural-related facilitators to engaging in care were noted.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Understanding Disparities in Antiretroviral Therapy Adherence and Sustained Viral Suppression Among Black, Hispanic/Latina, and White Women in the United States – Medical Monitoring Project, United States, 2015–2019

Raiford

Yuan²,

Carree³

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

Background: Racial and ethnic disparities in antiretroviral therapy (ART) adherence and sustained viral suppression (SVS) have been documented among women with HIV. We examined factors that may account for these racial/ethnic differences among women to inform interventions that increase health equity. Methods: We used data from the 2015–2019 cycles of the Medical Monitoring Project, a probability sample of U.S. adults with diagnosed HIV. Using logistic regression with predicted marginal means, we calculated weighted prevalence differences (PDs) of ART adherence and SVS among Black, Hispanic/Latina, and White women taking ART. Using modeling with forward stepwise selection, we adjusted PDs for selected variables, including social and structural determinants of health (SDOH) factors, to examine whether magnitude of PDs was attenuated by their inclusion. We assessed relative changes between unadjusted and adjusted PDs. Results: After adjusting for poverty, transportation needs, health literacy, and gap in health insurance/coverage, the Black–White PD in adherence decreased by 11% (−16.0% to −14.2%). After adjusting for adherence, poverty, type of health insurance, and gap in health insurance/coverage, the Black–White PD in SVS reduced 37% (−7.9% to −5.0%) and was no longer statistically different. The Hispanic/Latina–White PD in adherence reduced 24% (−12.7% to −9.6%) after adjusting for poverty, health literacy, and transportation needs. The unadjusted Hispanic/Latina–White PD in SVS was not significantly different. Conclusion: Racial/ethnic disparities in HIV outcomes among women taking ART were substantially reduced after accounting for SDOH and other factors although differences remained. Structural interventions to improve SDOH are needed to improve health equity for women with HIV.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Understanding Disparities in Antiretroviral Therapy Adherence and Sustained Viral Suppression Among Black, Hispanic/Latina, and White Women in the United States – Medical Monitoring Project, United States, 2015–2019

Raiford

Yuan²,

Carree³

et al. 2023

JAIDS Journal of Acquired Immune Deficiency Syndromes

View full text Add to dashboard Cite

show abstract

“…Despite these challenges, we were able to collect data from a diverse group of people with HIV. We have used some of these data to report on facilitators and barriers to HIV care engagement, improve our MMP data collection instrument, and inform MMP recruitment procedures [ 6 ]. In the following sections, we describe in more detail the challenges we faced and the lessons we learned.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, our objectives were to (1) describe the methodology of this project; (2) reflect on the challenges and lessons learned from conducting qualitative telephone interviews at a national level; and (3) describe how we used, and plan to use, the qualitative data to evaluate our recruitment procedures and quantitative data collection instrument, as well as knowledge of HIV care engagement. Our objectives do not include the discussion of findings from our project because they are reported elsewhere [ 6 ]. We felt that doing so would detract from our main objectives.…”

Section: Introductionmentioning

confidence: 99%

Using Semistructured Telephone Interviews to Collect Qualitative Data From People With HIV Who Are Not in Medical Care: Implementation Study

2022

Self Cite

View full text Add to dashboard Cite

Background The Medical Monitoring Qualitative (MMP-Qual) Project was designed to collect qualitative data from people with HIV not engaged in medical care that would complement quantitative data collected by the Medical Monitoring Project (MMP)—a national surveillance system—and inform the MMP’s recruitment and data collection methods. Objective Our objectives were to describe the methodology of this project, reflect on the challenges and lessons learned from conducting qualitative telephone interviews at a national level, and describe how we used and plan to use the qualitative data to evaluate our recruitment procedures and quantitative data collection instrument as well as knowledge of HIV care engagement. Methods We used stratified purposive sampling to identify and recruit participants who had participated in the structured MMP interview into the MMP-Qual Project. To be eligible, participants must have had an HIV diagnosis, be aged ≥18 years, have lived in an MMP jurisdiction, and have not been engaged in HIV medical care. From August 1, 2018, to May 31, 2019, we conducted semistructured telephone interviews with 36 people with HIV across the United States about several topics (eg, facilitators and barriers to care and experience with surveys). Four trained interviewers conducted semistructured 60-minute telephone interviews with 36 participants. Data collection lasted from August 1, 2018, to May 31, 2019. Results From 2018 to 2019, 113 people were eligible to participate in the MMP-Qual Project. Of the people recruited, 28% (22/79) refused to participate. Of those who agreed to participate, 63% (36/57) were interviewed, and 37% (21/57) were no-shows. Of the 34 participants for whom we had complete data, 15 (44%) were aged ≥50 years, 26 (76%) identified as male, 22 (65%) were Black or African American, and 12 (35%) lived in the Southern United States. Conclusions We learned that it is possible to obtain rich qualitative data from people with HIV who are not in care via telephone interviews and that this mode might be conducive to talking about sensitive topics. We also learned the importance of flexibility, communication, and coordination because we relied on health department staff to perform recruitment and had difficulty implementing our original sampling strategy. We hope that other projects will learn from our experience conducting qualitative telephone interviews with people with HIV on a national level. International Registered Report Identifier (IRRID) RR1-10.2196/40041

show abstract

Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models

Ahmed

Dujaili

Chuah

et al. 2023

Appl Health Econ Health Policy

View full text Add to dashboard Cite

Background Although safe and effective anti-retrovirals (ARVs) are readily available, non-adherence to ARVs is highly prevalent among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA). Different adherence-improving interventions have been developed and examined through decision analytic model-based health technology assessments. This systematic review aimed to review and appraise the decision analytical economic models developed to assess ARV adherence-improvement interventions. Methods The review protocol was registered on PROSPERO (CRD42022270039), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant studies were identified through searches in six generic and specialized bibliographic databases, i.e. PubMed, Embase, NHS Economic Evaluation Database, PsycINFO, Health Economic Evaluations Database, tufts CEA registry and EconLit, from their inception to 23 October 2022. The cost-effectiveness of adherence interventions is represented by the incremental cost-effectiveness ratio (ICER). The quality of studies was assessed using the quality of the health economics studies (QHES) instrument. Data were narratively synthesized in the form of tables and texts. Due to the heterogeneity of the data, a permutation matrix was used for quantitative data synthesis rather than a meta-analysis. Results Fifteen studies, mostly conducted in North America (8/15 studies), were included in the review. The time horizon ranged from a year to a lifetime. Ten out of 15 studies used a micro-simulation, 4/15 studies employed Markov and 1/15 employed a dynamic model. The most commonly used interventions reported include technology based (5/15), nurse involved (2/15), directly observed therapy (2/15), case manager involved (1/15) and others that involved multi-component interventions (5/15). In 1/15 studies, interventions gained higher quality-adjusted life years (QALYs) with cost savings. The interventions in 14/15 studies were more effective but at a higher cost, and the overall ICER was well below the acceptable threshold mentioned in each study, indicating the interventions could potentially be implemented after careful interpretation. The studies were graded as high quality (13/15) or fair quality (2/15), with some methodological inconsistencies reported. Conclusion Counselling and smartphone-based interventions are cost-effective, and they have the potential to reduce the chronic adherence problem significantly. The quality of decision models can be improved by addressing inconsistencies in model selection, data inputs incorporated into models and uncertainty assessment methods. Supplementary Information The online version contains supplementary material available at 10.1007/s40258-023-00818-4.

show abstract

The Boundary of HIV Care: Barriers and Facilitators to Care Engagement Among People with HIV in the United States

Cited by 16 publications

References 29 publications

Understanding Disparities in Antiretroviral Therapy Adherence and Sustained Viral Suppression Among Black, Hispanic/Latina, and White Women in the United States – Medical Monitoring Project, United States, 2015–2019

Understanding Disparities in Antiretroviral Therapy Adherence and Sustained Viral Suppression Among Black, Hispanic/Latina, and White Women in the United States – Medical Monitoring Project, United States, 2015–2019

Using Semistructured Telephone Interviews to Collect Qualitative Data From People With HIV Who Are Not in Medical Care: Implementation Study

Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models

Contact Info

Product

Resources

About