title: HIV-Infected Individuals Who Delay, Decline, or Discontinue Antiretroviral Therapy: Comparing Clinic- and Peer-Recruited Cohorts.
abstract: A substantial proportion of persons living with HIV/AIDS (PLHA) delay, decline, or discontinue antiretroviral therapy (ART) when it is medically indicated (40-45%), largely African-Americans and Latinos/Hispanics. This study explores the feasibility of locating PLHA, who are not on ART (PLHA-NOA) through clinics and peer-referral; compares the two cohorts on multi-level barriers to ART; and examines readiness to initiate/reinitiate ART, a predictor of treatment outcomes. We recruited adult HIV-infected African-American and Latino/Hispanic PLHA-NOA through HIV hospital clinics and peer-referral in 2012-2013. Participants were engaged in structured 1-h assessments with reliable/valid measures on barriers to ART. We found that recruitment through peers (63.2%, 60/95) was more feasible than in clinics (36.8%, 35/90). Participants were 48.0 years old and had lived with HIV for 14.7 years on average, and 56.8% had taken ART previously. Most (61.1%) were male and African-American (76.8%), and 23.2% were Latino/Hispanic. Peer-recruited participants were older, had lived with HIV longer, were less engaged in HIV care, and were more likely to have taken ART previously. The cohorts differed in reasons for discontinuing ART. Levels of ART knowledge were comparable between cohorts (68.5% correct), and there were no differences in attitudes toward ART (e.g., mistrust), which were in the neutral range. In bivariate linear regression, readiness for ART was negatively associated with physician mistrust (B = -10.4) and positively associated with self-efficacy (B = 5.5), positive outcome expectancies (B = 6.3), beliefs about personal necessity of ART (B = 17.5), and positive internal norms (B = 7.9). This study demonstrates the feasibility of engaging this vulnerable population through peer-referral. Peer-recruited PLHA evidence particularly high rates of risk factors compared to those in hospital clinics. Interventions to support ART initiation and continuation are sorely needed for both subgroups.
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Marya
authors: M
authors: Gwadz
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Elizabeth
authors: E
authors: Applegate
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Charles
authors: C
authors: Cleland
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Noelle Regina
authors: NR
authors: Leonard
authors: Spencer Cox Center for Health, Mount Sinai St. Luke's-Roosevelt Hospital Center , New York, NY , USA.
authors: Hannah
authors: H
authors: Wolfe
authors: Peter Kruger Clinic, Mount Sinai Beth Israel Medical Center , New York, NY , USA.
authors: Nadim
authors: N
authors: Salomon
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Mindy
authors: M
authors: Belkin
authors: School of Social Work, Columbia University , New York, NY , USA.
authors: Marion
authors: M
authors: Riedel
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Angela
authors: A
authors: Banfield
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Lisa
authors: L
authors: Sanfilippo
authors: Center for Drug Use and HIV Research (CDUHR), New York University, College of Nursing , New York, NY , USA.
authors: Andrea
authors: A
authors: Wagner
authors: Department of Infectious Diseases, Mount Sinai Beth Israel Medical Center , New York, NY , USA.
authors: Donna
authors: D
authors: Mildvan
keywords: African-American; HIV; Latino; antiretroviral; barriers; decline; delay; discontinue