Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade county

Andrew Wawrzyniak, Allan E Rodriguez, Anthony E. Falcon, Anindita Chakrabarti, Alexa Parra, Jane Park, Kathleen Mercogliano, Kira Villamizar, Michael A Kolber, Daniel J Feaster, Lisa R. Metsch

Research output: Contribution to journalArticle

17 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)S63-S72
JournalJournal of Acquired Immune Deficiency Syndromes
Volume69
DOIs
StatePublished - May 1 2015

Fingerprint

Acquired Immunodeficiency Syndrome
HIV
Viral Load
Depression
Physicians
Continuity of Patient Care
Food Supply
Electronic Health Records
CD4 Lymphocyte Count
Health Education
Appointments and Schedules
Outpatients
Odds Ratio
Quality of Life
Interviews
Health
Pharmaceutical Preparations

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 journalArticle

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. / Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade county. In: Journal of Acquired Immune Deficiency Syndromes. 2015 ; Vol. 69. pp. S63-S72.
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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.",
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