scholarly journals Adhering to antiretroviral therapy: A qualitative analysis of motivations for and obstacles to consistent use of antiretroviral therapy in people living with HIV

2020 ◽  
Vol 8 ◽  
pp. 205031212091540
Author(s):  
Lisa Fleischer ◽  
Ann Avery
Keyword(s):  
United States ◽  
Antiretroviral Therapy ◽  
Qualitative Analysis ◽  
The United States ◽  
Care Team ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Care Clinic ◽  
Main Motivation ◽  
Living With Hiv

Objectives: Based on the 2015 U.S. Centers for Disease Control and Prevention data, 40% of people living with HIV in the United States with an HIV diagnosis and 18.5% of people living with HIV in HIV care in the United States are not virally suppressed. Many HIV care clinics have implemented recommendations to improve the percentage of people living with HIV on antiretroviral therapy. To understand what more could be done, we examine patients’ motivations and obstacles to maintaining adherence to antiretroviral therapy. Methods: We conducted qualitative analysis using a qualitative description framework of in-depth interviews with people living with HIV receiving care at an urban HIV care clinic in the midwestern United States. Results: We found that while many traditional barriers to care have been addressed by existing programs, there are key differences between those consistent with antiretroviral therapy and those inconsistent with antiretroviral therapy. In particular, self-motivation, diagnosis acceptance, treatment for depression, spiritual beliefs, perceived value of the HIV care team, and prior experience with health care distinguish these two groups. Most significantly, we found that people living with HIV consistent with antiretroviral therapy describe their main motivation as coming from themselves, whereas people living with HIV inconsistent with antiretroviral therapy more often describe their main motivation as coming from the HIV care team. Conclusion: Our results highlight the importance of the HIV care team’s encouragement of maintaining antiretroviral adherence, as well as encouraging treatment for depression.

scholarly journals Social determinants of health and care outcomes among people living with HIV in the United States

2021 ◽  
Author(s):  
Timothy W Menza ◽  
Lindsay K Hixson ◽  
Lauren Lipira ◽  
Linda Drach
Keyword(s):  
United States ◽  
Social Determinants ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
Economic Disadvantage ◽  
People Living With Hiv ◽  
Care Outcomes ◽  
Durable Viral Suppression ◽  
Living With Hiv

Abstract Background Fewer than 70% of people living with HIV (PLHIV) in the United States have achieved durable viral suppression. To end the HIV epidemic in the United States, clinicians, researchers, and public health practitioners must devise ways to remove barriers to effective HIV treatment. To identify PLHIV who experience challenges to accessing healthcare, we created a simple assessment of social determinants of health (SDOH) among PLHIV and examined the impact of cumulative social and economic disadvantage on key HIV care outcomes. Methods We used data from the 2015-2019 Medical Monitoring Project, a yearly cross-sectional survey of PLHIV in the United States (N=15,964). We created a ten-item index of SDOH and assessed differences in HIV care outcomes of missed medical appointments, medication adherence, and durable viral suppression by SDOH using this index using prevalence ratios with predicted marginal means. Results Eighty-three percent of PLHIV reported at least one SDOH indicator. Compared to PLHIV who experienced none of the SDOH indicators, people who experienced one, two, three, and four or more SDOH indicators, were 1.6, 2.1, 2.6 and 3.6 as likely to miss a medical appointment in the prior year; 11%, 17%, 20% and 31% less likely to report excellent adherence in the prior 30 days; and, 2%, 4%, 10% and 20% less likely to achieve durable viral suppression in the prior year, respectively. Conclusions Among PLHIV, cumulative exposure to social and economic disadvantage impacts care outcomes in a dose-dependent fashion. A simple index may identify PLHIV experiencing barriers to HIV care, adherence, and durable viral suppression in need of critical supportive services.

scholarly journals 1316. Gathering Trauma Narratives: A Qualitative Study on the Impact of Traumas on People Living with HIV (PLWH)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S475-S475
Author(s):  
Doris Pierson ◽  
Vaidehi Mujumdar ◽  
Brittany Briceño ◽  
Elaina Cummer ◽  
Kshipra Hemal ◽  
...  
Keyword(s):  
United States ◽  
Reproductive Health ◽  
Viral Suppression ◽  
The United States ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Structured Interviews ◽  
Reproductive Intentions ◽  
Living With Hiv ◽  
The Impact

Abstract Background Trauma—emotional, physical, and psychological—is common and associated with increased risk behaviors, low rates of care engagement and viral suppression, and overall poor health outcomes for people living with HIV (PLWH). In the United States, there are limited data on how trauma affects reproductive health beliefs for PLWH and even less data on HIV providers’ understanding and consideration of these experiences in their approach to patients. Methods Fifteen semi-structured interviews were conducted with PLWH and nine semi-structured interviews were conducted with HIV care and service providers at an academic medical center in the Southeastern United States. Transcripts were analyzed using thematic analysis. Each transcript was coded by two investigators and discussed to ensure consensus. Results Participants’ narratives described diverse traumas, including sexual abuse (n = 6), the loss of a loved one (n = 8), and personal illness (n = 7). Types of trauma shared with providers included physical, sexual, illness, loss, and psychological. For patients, trauma was both a motivation for having children and a reason to stop having children. Providers perceived a variety of effects of trauma on both sexual behaviors and reproductive intentions. Reproductive counseling by HIV care providers (n = 5) focused on maintaining a healthy pregnancy and less on reproductive intentions prior to pregnancy. Reproductive discussions with pregnant female patients typically centered on reducing the risk of transmission in utero (including the importance of medication adherence to maintain viral suppression), what will happen during delivery, and breastfeeding risks. Reproductive discussions with males typically centered on preventing infection or re-infection of the mother. Conclusion PLWH interpret their trauma experiences differently, particularly when considering reproduction. Providers may not incorporate this information in counseling around reproductive health, highlighting the need fora trauma-informed healthcare practice that promotes awareness, education on the effect of past traumas on health, and access to appropriate resources. Disclosures All authors: No reported disclosures.

scholarly journals The Dose Response: Perceptions of People Living with HIV in the United States on Alternatives to Oral Daily Antiretroviral Therapy

2020 ◽  
Vol 36 (4) ◽  
pp. 324-348 ◽  
Author(s):  
Karine Dubé ◽  
Shadi Eskaf ◽  
David Evans ◽  
John Sauceda ◽  
Parya Saberi ◽  
...  
Keyword(s):  
United States ◽  
Antiretroviral Therapy ◽  
Dose Response ◽  
The United States ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals Current Challenges to the United States’ AIDS Drug Assistance Program and Possible Implications of the Affordable Care Act

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Kathleen A. McManus ◽  
Carolyn L. Engelhard ◽  
Rebecca Dillingham
Keyword(s):  
United States ◽  
Affordable Care Act ◽  
The United States ◽  
Lessons Learned ◽  
State Funding ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Assistance Program ◽  
The Affordable Care Act ◽  
Living With Hiv

AIDS Drug Assistance Programs, enacted through the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, are the “payer of last resort” for prescription medications for lower income, uninsured, or underinsured people living with HIV/AIDS. ADAPs face declining funding from the federal government. State funding of ADAP is discretionary, but some states increased their contributions to meet the gap in funding. The demand for ADAP support is increasing as people living with HIV are living longer; the antiretroviral therapy (ART) guidelines have been changed to recommend initiation of treatment for all; the United States is increasing HIV testing goals; and the recession continues. In the setting of increased demand and limited funding, ADAPs are employing cost containment measures. Since 2010, emergency federal funds have bailed out ADAP, but these are not sustainable. In the coming years, providers and policy makers associated with HIV care will need to navigate the implementation of the Affordable Care Act (ACA). Lessons learned from the challenges associated with providing sustainable access to ART for vulnerable populations through ADAP should inform upcoming decisions about how to ensure delivery of ART during and after the implementation of the ACA.

scholarly journals 3242 Stressful experiences and adherence to HIV care among Black Women Living with HIV: A qualitative analysis

2019 ◽  
Vol 3 (s1) ◽  
pp. 74-74
Author(s):  
Crystal Chapman Lambert ◽  
Chastity McDavid ◽  
Tammi F. Thomas ◽  
Kiko King ◽  
Andres Azuero ◽  
...  
Keyword(s):  
Social Support ◽  
Black Women ◽  
Physical Abuse ◽  
Traumatic Events ◽  
The United States ◽  
Stressful Events ◽  
Hiv Care ◽  
Care Clinic ◽  
Women Living With Hiv ◽  
Living With Hiv

OBJECTIVES/SPECIFIC AIMS: Our primary objective was to understand the relationship between incident or recent stressful events and adherence to HIV care in the context of other person, environment, and HIV-specific stressors in a sample of Black women living with HIV (WLWH). METHODS/STUDY POPULATION: Thirty in-depth interviews were conducted with Black women living with HIV who receive care at an academic HIV primary care clinic in the Southern region of the United States to elicit stressful events influencing adherence to HIV care. Semi-structured interview guides were used to facilitate discussion regarding stressful events and adherence to HIV care. Interviews were audiotaped and transcribed verbatim. Transcripts were independently coded using a theme-based approach by two experienced coders, findings were compared, and discrepancies were resolved by discussion. RESULTS/ANTICIPATED RESULTS: Participants described frequently experiencing incident stressful events including death or serious illness of a close friend or family member, and relationship, financial, and employment difficulties. Furthermore, participants reported experiencing traumatic events such as sexual and physical abuse during childhood and adolescents. While experiencing traumatic events such as sexual and physical abuse during childhood and adolescence may be distressing, these events did not influence adherence to HIV care. However, incident stressful events as defined above did influence adherence to HIV care for some participants, but not for others. For participants who reported that stressful events did not influence adherence to HIV care, factors such as personal motivation, access to social support, and adaptive coping strategies facilitated their engagement in care. DISCUSSION/SIGNIFICANCE OF IMPACT: Experiencing stressful events, incident or traumatic, is common among Black WLWH and have the potential to negatively influence adherence to HIV care. Thus, Interventions aimed at identifying and addressing stress, social support, and coping are essential to improve adherence to HIV care behaviors.

scholarly journals Association Between Bilirubin, Atazanavir, and Cardiovascular Disease Events Among People Living With HIV Across the United States

2019 ◽  
Vol 81 (5) ◽  
pp. e141-e147 ◽  
Author(s):  
Heidi M. Crane ◽  
Robin M. Nance ◽  
Susan R. Heckbert ◽  
Corey Ritchings ◽  
Lisa Rosenblatt ◽  
...  
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
The United States ◽  
People Living With Hiv ◽  
Living With Hiv

scholarly journals Heterogeneity in the costs of medical care among people living with HIV/AIDS in the United States

AIDS ◽  
2019 ◽  
Vol 33 (9) ◽  
pp. 1491-1500 ◽  
Author(s):  
Benjamin Enns ◽  
Emanuel Krebs ◽  
William C. Mathews ◽  
Richard D. Moore ◽  
Kelly A. Gebo ◽  
...  
Keyword(s):  
United States ◽  
Medical Care ◽  
The United States ◽  
People Living With Hiv ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals Discontinuation of Antiretroviral Therapy Among Adults Receiving HIV Care in the United States

2014 ◽  
Vol 66 (1) ◽  
pp. 80-89 ◽  
Author(s):  
Alison J. Hughes ◽  
Christine L. Mattson ◽  
Susan Scheer ◽  
Linda Beer ◽  
Jacek Skarbinski
Keyword(s):  
United States ◽  
Antiretroviral Therapy ◽  
The United States ◽  
Hiv Care

Leveraging a Legacy of Activism: Black Lives Matter and the Future of HIV Prevention for Black MSM

2018 ◽  
Vol 30 (3) ◽  
pp. 208-212
Author(s):  
Derrick D. Matthews
Keyword(s):  
United States ◽  
The United States ◽  
Aids Education ◽  
Black Msm ◽  
People Living With Hiv ◽  
Black Lives Matter ◽  
Aids Epidemic ◽  
Hiv Epidemic ◽  
Sex With Men ◽  
Living With Hiv

This year marks the 30th anniversary of AIDS Education and Prevention. As we approach the United Nations goal of ending the AIDS epidemic by 2030, it is a useful time to reflect on and learn from history. In the United States, no such endeavor can be successful without addressing the specific context of Black men who have sex with men. In this commentary I highlight factors that led us to a state in which Black MSM represent approximately a quarter of all people living with HIV in the United States. I also look back at the power of activism during the beginning of the HIV epidemic. Using Black Lives Matter as a contemporary framework, I highlight natural linkages between activism 30 years ago, its incarnation and relationship to public health today, and its promise as the way forward in achieving the elimination of AIDS for Black MSM by 2030.

HIV Advocacy

2017 ◽  
Author(s):  
Simon Collins ◽  
Tim Horn ◽  
Loon Gangte ◽  
Emmanuel Trenado ◽  
Vuyiseka Dubula
Keyword(s):  
United States ◽  
Western Europe ◽  
Active Role ◽  
The United States ◽  
People Living With Hiv ◽  
Community Responses ◽  
Relevant Today ◽  
Aids Crisis ◽  
The Face ◽  
Living With Hiv

Community responses to the AIDS crisis have changed traditional approaches to medicine, healthcare, health systems, and research. Earlier approaches were rooted in widespread discrimination against key affected populations who were already socially marginalized. The background of community responses, first in the United States and then in other regions, each has a special history. This chapter provides an overview of historical community responses to HIV and is written by activists from the United States, India, South Africa and Western Europe. Examples of key projects include the role of peer advocacy and treatment literacy, which have enabled people living with HIV to learn more about HIV and treatment, adherence, treatment choice, drug resistance, and pipeline research for better drugs in the future. The outcome of this advocacy is that people living with HIV have been empowered to take an active role in their healthcare. HIV advocacy also provides an example of how the international activism that has changed the face of global healthcare is rooted in similar principles developed by early HIV-positive activists and is just as relevant today.

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