Patient-Provider Relationships and Antiretroviral Therapy Adherence and Durable Viral Suppression Among Women with HIV, Miami-Dade County, Florida, 2021-2022

Modeling the Mediating Effects of HIV-Related Sigma on the Associations Between Race/Ethnicity and Antiretroviral Therapy Adherence and Viral Suppression Among Diverse Racial and Ethnic Minority Women with HIV

Racial and ethnic minority women with HIV experience higher levels of HIV-related stigma, have poorer adherence to antiretroviral therapy (ART), and lower viral suppression rates than men and white women with HIV. Using structural equation modeling, we examined the direct and indirect associations between race and ethnicity, ART adherence and viral suppression through HIV-related stigma dimensions (anticipated, internalized, and enacted) among 542 racial and ethnic minority women with HIV (37% Black [excluding Hispanic and Haitian]; 34% Hispanic [of any race]; 29% Haitian [of any race]) who completed a survey about women-centered HIV care. All paths from each racial and ethnic group to the mediators and outcomes were estimated in comparison to the overall sample estimates. Approximately 62% of participants were adherent to ART, and 91% were virally suppressed. Haitian ethnicity was associated with increased anticipated stigma (β = 0.33, 95% CI: 0.19, 0.47), decreased internalized stigma (β = - 0.16, 95% CI: - 0.31,- 0.02), and decreased viral suppression (β = - 0.48, 95% CI: - 0.91, - 0.15). Hispanic ethnicity was associated with increased viral suppression (β = 0.43, 95% CI: 0.13, 0.85) and decreased anticipated stigma (β = - 0.25, 95% CI: - 0.37, - 0.13). Black race was not associated with any of the variables examined. None of the HIV-related stigma dimensions had a significant mediating effect. Our findings highlight the need for in-depth qualitative research to understand the unique cultural beliefs/practices and perceptions about HIV within the Haitian population that drive HIV-related stigma and decreased viral suppression.

Insights on HIV Care Engagement Strategies from Seven Interventions Serving Key Populations in the United States: A Qualitative Study

As HIV diagnoses continue to decrease and rates of viral suppression increase in the United States, key populations of underserved individuals represent a disproportionate share of those left undiagnosed, unengaged in care, and not virally suppressed. In 2021, the Health Resources and Services Administration's HIV/AIDS Bureau funded 20 HIV care organizations across the United States to implement seven innovative evidence-based interventions to engage individuals in the following four focus areas: LGBTQ+ youth, people with substance-use disorder, individuals with incarceration experience, and those for whom telehealth may reduce barriers to care. This article explores themes of implementer experiences common across interventions serving the four focus areas. Data sources include key informant interviews (n = 94) with members of the implementation teams, observation, and document review. Thematic analytic methods were first inductive, identifying semantic themes from observation and document review, then deductive, selecting coded interview data for analysis of latent themes present and salient across focus areas. We identified three main themes as follows: (1) challenging by design, (2) enhanced client-centered care, and (3) leveraging relationships. We present these themes as distinct concepts and discuss how they operate in relation to one another using the Exploration, Preparation, Implementation, Sustainment framework. Teams implementing interventions to engage people with HIV who remain out of care may benefit from adopting the following: an enhanced client-centered orientation with a focus on understanding the context of clients' lives; a high level of organizational and programmatic flexibility; an individualized, trauma-informed approach to enrollment and intervention delivery; and thoughtfully cultivated relationships among implementers, clients, and organizational partners.

Using Causal Bayesian Networks to Assess the Role of Patient-Centered Care and Psychosocial Factors on Durable HIV Viral Suppression

We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean "provider knows patient as a person" score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.