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 J.
AU - Rodríguez, 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.
N1 - Funding Information:
The authors gratefully acknowledge use of the services and facilities of the Miami Center for AIDS Research (CFAR) Behavioral/Social Sciences and Community Outreach Core at the University of Miami, funded by NIH grant P30A1073961.
Funding Information:
The authors would like to acknowledge Shelia Findlay and Marcia Vidal for their contributions to this research. The authors gratefully acknowledge use of the services and facilities of the Miami Center for AIDS Research (CFAR) Behavioral/Social Sciences and Community Outreach Core at the University of Miami, funded by NIH grant P30A1073961.
Funding Information:
Supported by the Miami Center for AIDS Research (CFAR) Behavioral, Social Sciences, and Community Outreach Core at the University of Miami (P30A1073961) and through a CFAR ECHPP Administrative Supplement from the District of Columbia Developmental Center for AIDS Research (P30AI087714).
Publisher Copyright:
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2015/5
Y1 - 2015/5
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
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U2 - 10.1097/QAI.0000000000000572
DO - 10.1097/QAI.0000000000000572
M3 - Article
C2 - 25867780
AN - SCOPUS:84988699972
VL - 69
SP - S63-S72
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
SN - 1525-4135
ER -