Abstract
Barriers to retention in HIV care are detrimental to patients' progress along the HIV continuum of care. Previous literature has focused on individual, client-level barriers, and interventions to address them. In contrast, less work has examined the role of system-level barriers on HIV care outcomes. This study seeks to understand how individual and systemic barriers individually are associated with clinic appointment attendance and virologic suppression in HIV-infected patients attending the largest HIV clinic in Miami-Dade, FL. In addition, we examined the synergistic effects of these barriers as potential syndemic factors on these health outcomes. Barriers to clinic attendance were determined in a face-Toface study interview with 444 HIV-infected outpatients (187 regular attenders, 191 irregular attenders, and 66 nonattenders) identified from electronic medical records. Compared with the other attendance groups, nonattenders had higher viral loads, were less likely to be virologically suppressed, had lower CD4 counts, had higher depressive symptoms, life chaos, lower quality of life, and higher rates of food insecurity, and recent drug use. Additionally, nonattenders compared with regular attenders had lower physician relationship ratings, had lower medical information clarity and more often reported transportation as a barrier to clinic attendance. When viewed as a syndemic, compared with patients not reporting any barriers, patients with 3 or more individual-level barriers were more likely to have a detectable viral load (odds ratio = 3.60, 95% CI: 1.71 to 7.61). Our findings suggest that patients presenting to the clinic with multiple barriers should be prioritized for assistance and future interventions to improve retention in care. Interventions should address multiple individual and system-level barriers simultaneously with particular attention to addressing depressive symptoms, organizational skills, relationship with the physician, and HIV-related health education.
| Original language | English (US) |
|---|---|
| Pages (from-to) | S63-S72 |
| Journal | Journal of Acquired Immune Deficiency Syndromes |
| Volume | 69 |
| DOIs | |
| State | Published - May 1 2015 |
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Keywords
- Barriers to care
- Individual-level barriers
- Psychosocial factors
- Retention in care
- Syndemics
- Systemic-level barriers
ASJC Scopus subject areas
- Pharmacology (medical)
- Infectious Diseases
Cite this
Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade county. / Wawrzyniak, Andrew; Rodriguez, Allan E; Falcon, Anthony E.; Chakrabarti, Anindita; Parra, Alexa; Park, Jane; Mercogliano, Kathleen; Villamizar, Kira; Kolber, Michael A; Feaster, Daniel J; Metsch, Lisa R.
In: Journal of Acquired Immune Deficiency Syndromes, Vol. 69, 01.05.2015, p. S63-S72.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade county
AU - Wawrzyniak, Andrew
AU - Rodriguez, Allan E
AU - Falcon, Anthony E.
AU - Chakrabarti, Anindita
AU - Parra, Alexa
AU - Park, Jane
AU - Mercogliano, Kathleen
AU - Villamizar, Kira
AU - Kolber, Michael A
AU - Feaster, Daniel J
AU - Metsch, Lisa R.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Barriers to retention in HIV care are detrimental to patients' progress along the HIV continuum of care. Previous literature has focused on individual, client-level barriers, and interventions to address them. In contrast, less work has examined the role of system-level barriers on HIV care outcomes. This study seeks to understand how individual and systemic barriers individually are associated with clinic appointment attendance and virologic suppression in HIV-infected patients attending the largest HIV clinic in Miami-Dade, FL. In addition, we examined the synergistic effects of these barriers as potential syndemic factors on these health outcomes. Barriers to clinic attendance were determined in a face-Toface study interview with 444 HIV-infected outpatients (187 regular attenders, 191 irregular attenders, and 66 nonattenders) identified from electronic medical records. Compared with the other attendance groups, nonattenders had higher viral loads, were less likely to be virologically suppressed, had lower CD4 counts, had higher depressive symptoms, life chaos, lower quality of life, and higher rates of food insecurity, and recent drug use. Additionally, nonattenders compared with regular attenders had lower physician relationship ratings, had lower medical information clarity and more often reported transportation as a barrier to clinic attendance. When viewed as a syndemic, compared with patients not reporting any barriers, patients with 3 or more individual-level barriers were more likely to have a detectable viral load (odds ratio = 3.60, 95% CI: 1.71 to 7.61). Our findings suggest that patients presenting to the clinic with multiple barriers should be prioritized for assistance and future interventions to improve retention in care. Interventions should address multiple individual and system-level barriers simultaneously with particular attention to addressing depressive symptoms, organizational skills, relationship with the physician, and HIV-related health education.
AB - Barriers to retention in HIV care are detrimental to patients' progress along the HIV continuum of care. Previous literature has focused on individual, client-level barriers, and interventions to address them. In contrast, less work has examined the role of system-level barriers on HIV care outcomes. This study seeks to understand how individual and systemic barriers individually are associated with clinic appointment attendance and virologic suppression in HIV-infected patients attending the largest HIV clinic in Miami-Dade, FL. In addition, we examined the synergistic effects of these barriers as potential syndemic factors on these health outcomes. Barriers to clinic attendance were determined in a face-Toface study interview with 444 HIV-infected outpatients (187 regular attenders, 191 irregular attenders, and 66 nonattenders) identified from electronic medical records. Compared with the other attendance groups, nonattenders had higher viral loads, were less likely to be virologically suppressed, had lower CD4 counts, had higher depressive symptoms, life chaos, lower quality of life, and higher rates of food insecurity, and recent drug use. Additionally, nonattenders compared with regular attenders had lower physician relationship ratings, had lower medical information clarity and more often reported transportation as a barrier to clinic attendance. When viewed as a syndemic, compared with patients not reporting any barriers, patients with 3 or more individual-level barriers were more likely to have a detectable viral load (odds ratio = 3.60, 95% CI: 1.71 to 7.61). Our findings suggest that patients presenting to the clinic with multiple barriers should be prioritized for assistance and future interventions to improve retention in care. Interventions should address multiple individual and system-level barriers simultaneously with particular attention to addressing depressive symptoms, organizational skills, relationship with the physician, and HIV-related health education.
KW - Barriers to care
KW - Individual-level barriers
KW - Psychosocial factors
KW - Retention in care
KW - Syndemics
KW - Systemic-level barriers
UR - http://www.scopus.com/inward/record.url?scp=84988699972&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84988699972&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000000572
DO - 10.1097/QAI.0000000000000572
M3 - Article
VL - 69
SP - S63-S72
JO - Journal of acquired immune deficiency syndromes (1999)
JF - Journal of acquired immune deficiency syndromes (1999)
SN - 1525-4135
ER -