scholarly journals Physician Reimbursement and Retention in HIV Care: Racial Disparities in the US South

2021 ◽  
Author(s):  
Zhongzhe Pan ◽  
Bassam Dahman ◽  
Rose S Bono ◽  
Lindsay M Sabik ◽  
Faye Z Belgrave ◽  
...  
Keyword(s):  
Racial Disparities ◽  
Racial Differences ◽  
Hiv Care ◽  
Administrative Claims ◽  
Physician Reimbursement ◽  
Physician Visits ◽  
Retention In Hiv Care ◽  
Living With Hiv ◽  
Stratified Analysis ◽  
Hispanic White

Fewer than 60% of Americans diagnosed with HIV are retained in care, with racial disparities. Addressing structural barriers to care may improve outcomes along the HIV care continuum, such as retention, and promote health equity. We examined the relationship between physician reimbursement and retention in HIV care, including racial differences. Data included person-level demographic information and administrative claims (Medicaid Analytic eXtract, 2008-12), state Medicaid-to-Medicare fee ratios (Urban Institute, 2008, 2012), and county characteristics for 15 Southern states plus District of Columbia. The fee ratio is a standardized measure of physician reimbursement capturing state variation in Medicaid relative to Medicare physician reimbursement, which is largely consistent across states. We used generalized estimating equations to assess the association between physician reimbursement ratio and retention in HIV care (≥2 claims for physician visits, antiretroviral prescriptions, or CD4 or HIV RNA viral load tests >90 days apart in a calendar-year). We also evaluated an increase in the fee ratio to parity, where Medicaid and Medicare physician reimbursement are equal. Stratified analysis assessed racial differences. The sample included 55,237 adult Medicaid enrollees living with HIV (179,002 enrollee-years). Enrollees were retained in HIV care for approximately three-quarters (76.8%) of their enrollment-years, with retention lower among non-Hispanic Black (76.2%) versus non-Hispanic White (81.3%, p<0.001) enrollees. A 10-percentage point increase in physician reimbursement was associated with a 4% increase in the odds of retention (aOR 1.04, 95% CI 1.01, 1.08). In stratified analysis, increased physician reimbursement was significantly associated with retention among non-Hispanic Black but not non-Hispanic White enrollees. At parity, predicted retention was 81.1% (80.0%, 82.1%) and 80.4% (79%, 81.7%) of enrollment-years, overall and for non-Hispanic Black enrollees, respectively. Higher physician reimbursement improves retention in HIV care, particularly among non-Hispanic Black individuals living with HIV, and could be a structural mechanism to promote racial equity in retention.

scholarly journals Low Birthweight, Retention in HIV Care, and Adherence to ART Among Postpartum Women Living with HIV in Ghana

2018 ◽  
Vol 23 (2) ◽  
pp. 433-444 ◽  
Author(s):  
Kwame S. Sakyi ◽  
Margaret Y. Lartey ◽  
Julie A. Dension ◽  
Caitlin E. Kennedy ◽  
Luke C. Mullany ◽  
...  
Keyword(s):  
Low Birthweight ◽  
Hiv Care ◽  
Postpartum Women ◽  
Women Living With Hiv ◽  
Retention In Hiv Care ◽  
Living With Hiv

scholarly journals Association Between Depression and HIV Care Engagement Outcomes Among Patients Newly Initiating ART in Lilongwe, Malawi

2020 ◽  
Author(s):  
Melissa A. Stockton ◽  
Bradley N. Gaynes ◽  
Mina C. Hosseinipour ◽  
Audrey E. Pettifor ◽  
Joanna Maselko ◽  
...  
Keyword(s):  
Viral Suppression ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Load Testing ◽  
Art Initiation ◽  
Retention In Hiv Care ◽  
Hiv Care Engagement ◽  
Care Outcomes ◽  
Sub Saharan ◽  
Living With Hiv

Abstract As in other sub-Saharan countries, the burden of depression is high among people living with HIV in Malawi. However, the association between depression at ART initiation and two critical outcomes—retention in HIV care and viral suppression—is not well understood. Prior to the launch of an integrated depression treatment program, adult patients were screened for depression at ART initiation at two clinics in Lilongwe, Malawi. We compared retention in HIV care and viral suppression at 6 months between patients with and without depression at ART initiation using tabular comparison and regression models. The prevalence of depression among this population of adults newly initiating ART was 27%. Those with depression had similar HIV care outcomes at 6 months to those without depression. Retention metrics were generally poor for those with and without depression. However, among those completing viral load testing, nearly all achieved viral suppression. Depression at ART initiation was not associated with either retention or viral suppression. Further investigation of the relationship between depression and HIV is needed to understand the ways depression impacts the different aspects of HIV care engagement.

scholarly journals Multilevel Factors Underlying Adolescent Retention and Disengagement in HIV Care

2020 ◽  
Vol 3 ◽  
Author(s):  
Nathan Risk ◽  
Judith Toromo ◽  
Chelsea Misquith ◽  
Leslie Enane
Keyword(s):  
Policy Implications ◽  
Barriers And Facilitators ◽  
Hiv Care ◽  
Care Providers ◽  
Hiv Status ◽  
Travel Costs ◽  
Retention In Hiv Care ◽  
Full Text Review ◽  
Anticipated Stigma ◽  
Living With Hiv

Background/Objective: Adolescents (ages 10-19) living with HIV are at risk for disengagement from HIV care, resulting in poor health and potential for viral transmission. It is important to uncover the central barriers that result in adolescents becoming disengaged from care in order to develop interventions or models to support adolescent retention. We sought to investigate the multilevel barriers and facilitators to adolescent retention in HIV care.    Methods: A systematic search was performed to identify relevant studies from 1994 onwards, both qualitative and quantitative, in any language, and in all geographic regions. Title and abstract screening identified relevant articles. A full text review determined final inclusion. Key variables were extracted, focused on the range of multilevel barriers and facilitators to retention, and any differences according to population or setting. Preliminary findings are summarized.    Results: Quantitative factors associated with disengagement include: older adolescence, racial or ethnic minority status, family-level poverty, and receiving care at a rural clinic. Qualitative barriers to retention include: distance to the clinic and associated travel costs, psychosocial challenges and lack of support for them, anticipated stigma with inadvertent disclosure of HIV status, nondisclosure of HIV status to both the adolescent and family members, negative experiences with care providers, challenges requesting absence from school, and negative school environments. Facilitators to retention include: having strong social support, having a family member with HIV, having positive relationships with providers and clinic staff, attending an adolescent-dedicated clinic or a clinic with adolescent-dedicated hours, having access to intensive counseling, and having access to peer groups/peer mentors.     Conclusion and Policy Implications: Improving adolescent retention requires addressing the multilevel factors that lead to disengagement. Interventions with potential to mitigate against the range of challenges adolescents face are needed to support adolescents to overcome these challenges and continue in life-long HIV care. 

scholarly journals Examining the relationship between interpersonal support and retention in HIV care among HIV+ nursing mothers in Uganda

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Jerry John Nutor ◽  
Pascal Agbadi ◽  
Thomas J. Hoffmann ◽  
Geoffrey Anguyo ◽  
Carol S. Camlin
Keyword(s):  
Sub Saharan Africa ◽  
Hiv Care ◽  
Interpersonal Support ◽  
Women Living With Hiv ◽  
Retention In Hiv Care ◽  
Nursing Mothers ◽  
Pediatric Populations ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Relationship

Abstract Objective The global burden of HIV on women and pediatric populations are severe in sub-Saharan Africa. Global child HIV infection rates have declined, but this rate remains quite high in sub-Saharan Africa due to Mother-to-child transmission (MTCT). To prevent MTCT of HIV, postpartum women living with HIV (WLHIV) are required to return to a health facility for HIV care within 60 days after childbirth (Retention in HIV care). Studies suggest that interpersonal support was positively associated with retention in HIV care. However, information on this association is lacking among postpartum WLHIV in Uganda. Therefore, this study investigates the relationship between interpersonal support, measured with the Interpersonal Support Evaluation List (ISEL-12), and retention in HIV care. Results In a total of 155 postpartum WLHIV, 84% were retained in HIV care. ISEL-12 was negatively associated with retention in HIV care. Postpartum WLHIV retained in care (24.984 ± 4.549) have lower ISEL-12 scores compared to the non-retained group (27.520 ± 4.224), t(35.572) = − 2.714, p = 0.01. In the non-income earning sample, respondents retained in care (24.110 ± 4.974) have lower ISEL scores compared to the non-retained group (27.000 ± 4.855), t(20.504) = -2.019, p = 0.049. This was not significant among income earning WLHIV.

scholarly journals Practical and Ethical Concerns in Implementing Enhanced Surveillance Methods to Improve Continuity of HIV Care: Qualitative Expert Stakeholder Study (Preprint)

2020 ◽  
Author(s):  
Mara Buchbinder ◽  
Colleen Blue ◽  
Stuart Rennie ◽  
Eric Juengst ◽  
Lauren Brinkley-Rubinstein ◽  
...  
Keyword(s):  
A Priori ◽  
The United States ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Ethical Concerns ◽  
Retention In Hiv Care ◽  
Semistructured Interviews ◽  
Privacy And Confidentiality ◽  
Living With Hiv

BACKGROUND Retention in HIV care is critical to maintaining viral suppression and preventing further transmission, yet less than 50% of people living with HIV in the United States are engaged in care. All US states have a funding mandate to implement Data-to-Care (D2C) programs, which use surveillance data (eg, laboratory, Medicaid billing) to identify out-of-care HIV-positive persons and relink them to treatment. OBJECTIVE The purpose of this qualitative study was to identify and describe practical and ethical considerations that arise in planning for and implementing D2C. METHODS Via purposive sampling, we recruited 43 expert stakeholders—including ethicists, privacy experts, researchers, public health personnel, HIV medical providers, legal experts, and community advocates—to participate in audio-recorded semistructured interviews to share their perspectives on D2C. Interview transcripts were analyzed across a priori and inductively derived thematic categories. RESULTS Stakeholders reported practical and ethical concerns in seven key domains: permission and consent, government assistance versus overreach, privacy and confidentiality, stigma, HIV exceptionalism, criminalization, and data integrity and sharing. CONCLUSIONS Participants expressed a great deal of support for D2C, yet also stressed the role of public trust and transparency in addressing the practical and ethical concerns they identified. CLINICALTRIAL

scholarly journals Women of Reproductive Age Living with HIV in Argentina: Unique Challenges for Reengagement in Care

2019 ◽  
Vol 18 ◽  
pp. 232595821988325
Author(s):  
Diego Cecchini ◽  
Maria Luisa Alcaide ◽  
Violeta de Jesus Rodriguez ◽  
Lissa Nicole Mandell ◽  
John Michael Abbamonte ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Latent Class ◽  
Hiv Transmission ◽  
Reproductive Age ◽  
Hiv Care ◽  
Women Of Reproductive Age ◽  
Physician Visits ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
Disproportionate Burden

This study evaluated the reasons for not taking antiretroviral treatment (ART) among women of reproductive age who are disengaged from HIV care (have missed pharmacy pickups and physician visits), with the goal of identifying strategies for reengagement in HIV care. Participants were cisgender women (n = 162), 18 to 49 years of age, and who completed sociodemographic, medical history, reasons why they were not taking ART, mental health, motivation, and self-efficacy assessments. Latent class analysis was used for analysis. Women who reported avoidance-based coping (avoid thinking about HIV) had higher depression ( U = 608.5, z = −2.7, P = .007), lower motivation ( U = 601, z = −2.8, P = .006), and lower self-efficacy ( U = 644.5, z = −2.4, P = .017) than those not using this maladaptive strategy. As women living with HIV experience a disproportionate burden of poor health outcomes, interventions focused on the management of depression may improve HIV outcomes and prevent HIV transmission.

The individual, interactive, and syndemic effect of substance use, depression, education, and ethnicity on retention in HIV care

2020 ◽  
pp. 095646241989072
Author(s):  
Kristopher Myers ◽  
Tan Li ◽  
Marianna Baum ◽  
Gladys Ibanez ◽  
Kristopher Fennie
Keyword(s):  
Logistic Regression ◽  
Alcohol Use ◽  
Alcohol Use Disorder ◽  
Male Gender ◽  
Hiv Care ◽  
Negatively Associated ◽  
Retention In Hiv Care ◽  
The Individual ◽  
Racial Ethnic ◽  
Hispanic White

In this study, we sought to assess the individual, syndemic, and interactive associations between individual-level factors and retention in care. The sample was derived from the Miami Adult Studies on human immunodeficiency virus (HIV)/ acquired immune deficiency syndrome (AIDS) cohort from 2009 to 2014. The variables were entered into a multiple logistic regression with retention as the outcome. Backward regression, adjusting for all main effects, was conducted to determine which two-way interactions were associated with retention. Multivariable logistic regression was used to test which number of factors were associated with retention. Non-Hispanic Black race/ethnicity was associated with improved retention (odds ratio [OR] = 2.44, 95% confidence interval [CI]: 1.06–5.75, p ≤ 0.05) when compared to Non-Hispanic White persons. Black-Hispanic and Other racial/ethnic identities were associated with increased retention (OR = 4.84, 95%CI: 1.16–25.79, p ≤ 0.05 and OR = 7.24, 95%CI: 1.54–54.05, p ≤ 0.05, respectively) when compared to Non-Hispanic White persons. The interaction between depressive symptoms and Alcohol Use Disorder Identification Test (AUDIT, a test that assesses alcohol use disorder) score was significantly and negatively associated with retention in HIV care (OR = 0.14, 95%CI: 0.01–1.11, p ≤ 0.10). The interaction between age and male gender was also negatively associated with retention (OR = 0.95, 95%CI: 0.88–1.01, p ≤ 0.10), and the interaction between male gender and depression was positively associated with retention (OR = 7.17, 95%CI: 0.84–98.49, p ≤ 0.10). In conclusion, multiple races/ethnicities, specifically Non-Hispanic Black, Black-Hispanic, and Other racial/ethnic identification, were associated with increased odds of retention. Multiple interactions, specifically depressive symptoms * alcohol use disorder and male gender * age, were negatively associated with retention. The male gender * depression interaction was positively associated with retention in HIV care.

scholarly journals Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV (Preprint)

2018 ◽  
Author(s):  
Colleen Laurence ◽  
Erin Wispelwey ◽  
Tabor E Flickinger ◽  
Marika Grabowski ◽  
Ava Lena Waldman ◽  
...  
Keyword(s):  
Mobile Phone ◽  
Retention In Care ◽  
Hiv Care ◽  
Just In Time ◽  
People Living With Hiv ◽  
Message Board ◽  
Retention In Hiv Care ◽  
High Participation ◽  
Living With Hiv ◽  
Usability Feedback

BACKGROUND Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). OBJECTIVE This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. METHODS App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. RESULTS A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. CONCLUSIONS The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV.

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