Predictors of disparities in retention in care among African Americans living with HIV

Multilevel Resilience and Appointment Attendance Among African American/Black Adults with HIV: A Prospective Multisite Cohort Study

BACKGROUND

Attending clinic appointments supports HIV viral suppression, yet racial disparities are documented. We assessed whether multilevel resilience resources were associated with appointment attendance among African American/Black (AA/B) adults living with HIV in the United States.

METHODS

We ascertained data from 291 AA/B clinical cohort participants from 2018 to 2021. We assessed resilience using the Multilevel Resilience Resource Measure. Binary outcomes were a nonrepeated indicator of attending ≥87.5% of scheduled HIV appointments over 12 months (i.e., visit adherence) and a repeated measure of attending appointments during two sequential 6-month follow-up windows (i.e., clinic attendance). Modified Poisson models estimated adjusted risk ratios (aRRs).

RESULTS

The aRR for clinic attendance among participants with greater versus lesser multilevel resilience resource endorsement was 0.95 (95% confidence interval: 0.88, 1.0). The aRR for visit adherence among participants with greater versus lesser multilevel resilience resource endorsement was 1.2 (0.95, 1.4).

CONCLUSIONS

This analysis is one of the first to assess appointment attendance as a function of resilience. Findings should be confirmed in larger cohorts.

Self-efficacy and consistent condom use by people living with HIV and seroconcordant and serodiscordant sexual partners in the Ceará, Brazil

The objectives were to assess the self-efficacy and consistent condom use by people living with HIV (PLHIV). A cross-sectional, comparative study was carried out in outpatient clinics in Ceará State, Brazil, with a sample of 190 PLHIV, 95 serodiscordant and 95 seroconcordant. Interviews were conducted using the Socio-Demographic, Clinical, Epidemiological and Vulnerability Form and the Condom Use Self-Efficacy Scale. Descriptive analysis, associations between variables, odds ratio and 95% confidence interval were determined. P < 0.05 was considered statistically significant. Of the sample, 43.1% consistently used condoms (50.5% serodiscordant and 35.7% seroconcordant). Serodiscordant PLHIV without guidance on HIV prevention (P = 0.027) and without access to testing (P = 0.002) had lower self-efficacy and 11.5 times more chances for inconsistent condom use (P = 0.006), while those satisfied with follow-up in health were less likely to use condoms inconsistently (P = 0.011). We conclude that there is low consistent use of condoms among PLHIV, which increases the risk of HIV transmission and the acquisition of other sexually transmitted infections. Consistent condom use was greater among serodiscordant individuals, although there was no difference in self-efficacy in condom use between the groups.

The Role of the Multidisciplinary HIV Care Center in Mitigating Social Isolation Among Patients with HIV During the Early COVID-19 Pandemic

As the COVID-19 pandemic began in 2020, significant public health mitigation efforts were vital to combat an unprecedented health crisis. These efforts, which involved social distancing and self-quarantine, likely worsened a public health crisis of social isolation and loneliness in the U.S., particularly among people with HIV (PWH). Multidisciplinary HIV care centers, which served as the main source of clinical care for PWH and in some cases the only point of social contact, faced evolving dynamics of in-person visits during the COVID-19 pandemic, as well as a shift to telehealth services. Using in-depth interviews, we explored the role that multidisciplinary HIV care centers and providers played in the experience of social isolation among PWH in New York City. We recruited participants (n = 30) from a multidisciplinary HIV care center in NYC between October 2020 and June 2021. We conducted semi-structured interviews to understand the specific domains of social isolation that were mitigated. In this cohort, the major theme that drove both in-person and telehealth care continuity was the strength of the patient-provider relationship. We found that participants saw members of the HIV care center as part of their social network, and providers served both as a source of emotional support and provided important social resources and benefits. Thus, in times of heightened social isolation, HIV care centers can play a critical role in providing social support in addition to clinical care.

HIV Knowledge among African Americans Living with HIV in the Rural South: Implications for Improving HIV Prevention and Care Outcomes

PURPOSE

This study examines the HIV knowledge of people living with HIV (PLWH) and its implications for improved healthcare outcomes.

METHODS

The study design was a descriptive cross-sectional study, and a total of 41 PLWH were recruited from a larger faith-based anti-stigma study. Data was collected using a semi-structured self-administered questionnaire and analyzed using SAS. In addition, a literature review was conducted using search engines to gauge existing literature from 2013 to 2022 in areas of HIV knowledge and healthcare outcomes among PLWH.

RESULTS

The 41 PLWH enrolled consisted of 51% males and 49% females. Sixteen (39%) were aged ≥ 51 years, 17 (41%) had been living with HIV for > 10 years, 15 (37%) had < high school diploma, and 100% were currently in HIV care. HIV knowledge scores were below average for 20 (49%) of the PLWH. Substantial knowledge deficits were noted in areas of HIV transmission and risk reduction strategies. Lower scores were not significantly associated with the participant's gender, education level, or length of time being HIV-infected. The results of the literature review showed limited research in this area.

CONCLUSIONS

The study and literature review results show that HIV knowledge and health literacy may contribute to racial disparities in retention in care leading to poor health outcomes. Healthcare providers and health facilities in rural areas should be equipped with culturally tailored HIV educational tools to strengthen ongoing care for PLWH, foster patient-provider relationships, and eliminate internalized stigma detrimental to improved healthcare outcomes among PLWH.

The role of perceived health in retention disparity: A HIV-testing-related behavioral intervention among African American and Latinx men who have sex with men in the United States

Retention in healthcare and health behavior remains a critical issue, contributing to inequitable distribution of intervention benefits. In diseases such as HIV, where half of the new infections occur among racial and sexual minorities, it is important that interventions do not enlarge pre-existing health disparities. To effectively combat this public health issue, it is crucial that we quantify the magnitude of racial/ethnic disparity in retention. Further, there is a need to identify mediating factors to this relationship to inform equitable intervention design. In the present study, we assess the racial/ethnic disparity in retention in a peer-led online behavioral intervention to increase HIV self-testing behavior and identify explanatory factors. The research used data collected from the Harnessing Online Peer Education (HOPE) HIV Study that included 899 primarily African American and Latinx men who have sex with men (MSM) in the United States. Results show that African American participants had higher lost-to-follow-up rates at 12-week follow-up compared to Latinx participants (11.1% and 5.8% respectively, Odds Ratio = 2.18, 95% confidence interval: 1.12 - 4.11, p = 0.02), which is substantially mediated by participants' self-rated health score (14.1% of the variation in the African American v.s. Latinx difference in lost-follow-up, p = 0.006). Thus, how MSM perceive their health may play an important role in their retention in HIV-related behavioral intervention programs and its racial/ethnic disparity.

Neurocognitive performance differences between black and white individuals with HIV disease are mediated by health literacy

Objective:Health disparities are evident for Black Americans with HIV disease, who are disproportionally affected by the epidemic in the United States. The current study investigated whether the higher rates of neurocognitive impairment in Black Americans with HIV disease may be at least partly attributable to health literacy, which is a potentially modifiable factor. Method: Participants were 61 White and 25 Black participants (ages 27-70) with HIV disease who were enrolled in studies at an urban academic center in Southern California. Neurocognitive function was assessed by an age-adjusted global score from the Cogstate battery. Health literacy was measured by a composite score derived from the Rapid Estimate of Adult Literacy in Medicine, Newest Vital Sign, and 3-Brief. Results: Bootstrap confidence interval mediation analyses showed that health literacy was a significant mediator of the relationship between race and neurocognition; that is, there were no direct ethnoracial differences in neurocognition after accounting for health literacy. A follow-up model to confirm the directionality of this association demonstrated that neurocognition was not a significant mediator of the relationship between race and health literacy. Conclusions: Low health literacy may contribute to the higher rates of neurocognitive impairment for Black Americans with HIV disease. Future studies might examine the possible mechanism of this mediating relationship (e.g., access to health information, health behaviors, socioeconomics) and determine whether culturally tailored interventions that improve health literacy also confer broader brain health benefits for Black Americans with HIV disease.