Older African Americans and the HIV Care Continuum: A Systematic Review of the Literature, 2003–2018

Abstract For people living with HIV, there are multiple barriers to engagement with care. This study qualitatively examines the role of use of alcohol and other drugs (AOD) on the health and management of Human Immunodeficiency Virus (HIV) disease among older African Americans (≥50 years). It draws on interviews conducted with twenty-seven older African Americans living with HIV in the Louisville, Kentucky area. Interviews were transcribed verbatim and then analyzed using constructivist grounded theory analytic techniques. Participants’ understandings of their AOD use fell on a continuum of problematic use to use for self-care. Regardless of where participants fell on this continuum, they faced a) environmental impacts of AOD use and b) current or historic discrimination from the health care system. The analysis focused on gaining a deeper understanding of the intersection of AOD use and engagement in the HIV care continuum. This revealed six major phases, which occurred at various stages of the continuum: (1) Linking AOD use as the cause of HIV diagnosis (2) Having AOD use facilitate denial of HIV, (3) Experiencing problematic use, (4) “Testing the Waters,” (5) Relying on AIDS Service Organizations (ASO) and medical providers and (6) Maintaining health and/or using AOD for self-care. We discuss the ways that stigma along the lines of race, gender, and age intersect with co-occurring conditions such as substance use disorders in complex and multifaceted ways. Recommendations include assessing a patients’ AOD use in relationship to the HIV care continuum to assess patients’ experiences and barriers within systems of care.

Download Full-text

African American Clergy Perspectives About the HIV Care Continuum: Results From a Qualitative Study in Jackson, Mississippi

Ethnicity & Disease ◽

10.18865/ed.28.2.85 ◽

2018 ◽

Vol 28 (2) ◽

pp. 85 ◽

Cited By ~ 4

Author(s):

Amy Nunn ◽

Sharon Parker ◽

Katryna McCoy ◽

Mauda Monger ◽

Melverta Bender ◽

...

Keyword(s):

African American ◽

African Americans ◽

Hiv Infection ◽

Racial Disparities ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum ◽

Adherence To Medication ◽

African American Clergy ◽

American Clergy

Mississippi has some of the most pronounced racial disparities in HIV infection in the country; African Americans comprised 37% of the Mississippi population but represented 80% of new HIV cases in 2015. Improving outcomes along the HIV care continuum, including linking and retaining more individuals and enhancing adherence to medication, may reduce the disparities faced by African Americans in Mississippi. Little is understood about clergy’s views about the HIV care continuum. We assessed knowledge of African American pastors and ministers in Jackson, Mississippi about HIV and the HIV care continuum. We also assessed their willingness to promote HIV screening and biomedical prevention technologies as well as efforts to enhance linkage and retention in care with their congregations. Four focus groups were conducted with 19 African American clergy. Clergy noted pervasive stigma associated with HIV and believed they had a moral imperative to promote HIV awareness and testing; they provided recommendations on how to normalize conversations related to HIV testing and treatment. Overall, clergy were willing to promote and help assist with linking and retaining HIV positive individuals in care but knew little about how HIV treatment can enhance prevention or new biomedical technologies such as pre-exposure prophylaxis (PrEP). Clergy underscored the importance of building coalitions to promote a collective local response to the epidemic. The results of this study highlight important public health opportunities to engage African American clergy in the HIV care continuum in order to reduce racial disparities in HIV infection. Ethn Dis.2018; 28(2): 85-92; doi:10.18865/ed.28.2.85.

Download Full-text

Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis

AIDS and Behavior ◽

10.1007/s10461-021-03551-y ◽

2021 ◽

Author(s):

Vasiliki Papageorgiou ◽

Bethan Davies ◽

Emily Cooper ◽

Ariana Singer ◽

Helen Ward

Keyword(s):

Systematic Review ◽

Social Determinants ◽

Meta Analysis ◽

Hiv Treatment ◽

Material Deprivation ◽

Hiv Care ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

Living With Hiv

AbstractDespite developments in HIV treatment and care, disparities persist with some not fully benefiting from improvements in the HIV care continuum. We conducted a systematic review to explore associations between social determinants and HIV treatment outcomes (viral suppression and treatment adherence) in high-income countries. A random effects meta-analysis was performed where there were consistent measurements of exposures. We identified 83 observational studies eligible for inclusion. Social determinants linked to material deprivation were identified as education, employment, food security, housing, income, poverty/deprivation, socioeconomic status/position, and social class; however, their measurement and definition varied across studies. Our review suggests a social gradient of health persists in the HIV care continuum; people living with HIV who reported material deprivation were less likely to be virologically suppressed or adherent to antiretrovirals. Future research should use an ecosocial approach to explore these interactions across the lifecourse to help propose a causal pathway.

Download Full-text

Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-017-1687-8 ◽

2017 ◽

Vol 21 (7) ◽

pp. 2101-2123 ◽

Cited By ~ 18

Author(s):

Kathryn A. Risher ◽

Sunaina Kapoor ◽

Alice Moji Daramola ◽

Gabriela Paz-Bailey ◽

Jacek Skarbinski ◽

...

Keyword(s):

United States ◽

Systematic Review ◽

The United States ◽

Hiv Care ◽

Hiv Care Continuum ◽

Care Continuum

Download Full-text

Effectiveness of Financial Incentives in Achieving UNAID Fast-Track 90-90-90 and 95-95-95 Target of HIV Care Continuum: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

AIDS and Behavior ◽

10.1007/s10461-020-03038-2 ◽

2020 ◽

Author(s):

Yuvaraj Krishnamoorthy ◽

Tanveer Rehman ◽

Manikandanesan Sakthivel

Keyword(s):

Systematic Review ◽

Randomized Controlled Trials ◽

Financial Incentives ◽

Fast Track ◽

Meta Analysis ◽

Hiv Care ◽

Controlled Trials ◽

Hiv Care Continuum ◽

Care Continuum ◽

Randomized Controlled

Download Full-text

Interventions to Reduce Loss to Follow-up During All Stages of the HIV Care Continuum in Sub-Saharan Africa: A Systematic Review

AIDS and Behavior ◽

10.1007/s10461-016-1532-5 ◽

2016 ◽

Vol 21 (6) ◽

pp. 1745-1754 ◽

Cited By ~ 18

Author(s):

Justin Keane ◽

Jennifer R. Pharr ◽

Mark P. Buttner ◽

Echezona E. Ezeanolue

Keyword(s):

Systematic Review ◽

Sub Saharan Africa ◽

Hiv Care ◽

Hiv Care Continuum ◽

Loss To Follow Up ◽

Care Continuum ◽

Sub Saharan

Download Full-text

Barriers to HIV care among Francophone African, Caribbean and Black immigrant people living with HIV in Canada: a protocol for a scoping systematic review

BMJ Open ◽

10.1136/bmjopen-2018-027440 ◽

2019 ◽

Vol 9 (1) ◽

pp. e027440 ◽

Cited By ~ 2

Author(s):

Pascal Djiadeu ◽

Joseph Nguemo ◽

Chantal Mukandoli ◽

Apondi J Odhiambo ◽

David Lightfoot ◽

...

Keyword(s):

Systematic Review ◽

Social Determinant ◽

Hiv Care ◽

Published Data ◽

People Living With Hiv ◽

Hiv Care Continuum ◽

Care Continuum ◽

French Speaking ◽

Living With Hiv ◽

The Impact

IntroductionLanguage is a social determinant of health. Addressing social determinants of health is paramount to successful progression along the HIV-care continuum. Canada is a bilingual country with French and English as official languages. There are few studies to date that have focused on the impact of being a French-speaking linguistic minority on the HIV-care continuum. The primary objective of this scoping, systematic review of literature is to evaluate existing gaps in access to HIV- care among French-speaking people living with HIV in Canada. Our primary outcome is healthcare services availability and access for French- speaking people living with HIV.Methods and analysesOur scoping, systematic review will draw on a systematic search of published literature, both quantitative and qualitative studies published on French-speaking individuals' healthcare and HIV status in Canada, with particular emphasis on the province of Ontario. We will conduct our search in MEDLINE, the Excerpta Medica Database, the Cumulative Index to Nursing and Allied Health Literature, Web of Science, EBSCO and Google Scholar for work published between 1990 and 2018. Identified articles will be screened in duplicate and full-text articles of relevant studies will be retrieved. Data will also be extracted by two researchers working independently. Any discrepancies that arise will be resolved by consensus or by consulting a third author. Our findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationOur proposed research will not be conducted with human participants. We will only use secondary published data and therefore ethics approval is not required. Our findings will be disseminated as peer reviewed manuscripts at conferences and student rounds, and could be of interest to government health agencies and local HIV/AIDS service organisations.

Download Full-text