title: Association of individual and systemic barriers to optimal medical care in people living with HIV/AIDS in Miami-Dade County.
abstract: Barriers to retention in HIV care are detrimental to patients' progress along the HIV continuum of care. Previous literature has focused on individual, client-level barriers, and interventions to address them. In contrast, less work has examined the role of system-level barriers on HIV care outcomes. This study seeks to understand how individual and systemic barriers individually are associated with clinic appointment attendance and virologic suppression in HIV-infected patients attending the largest HIV clinic in Miami-Dade, FL. In addition, we examined the synergistic effects of these barriers as potential syndemic factors on these health outcomes. Barriers to clinic attendance were determined in a face-to-face study interview with 444 HIV-infected outpatients (187 regular attenders, 191 irregular attenders, and 66 nonattenders) identified from electronic medical records. Compared with the other attendance groups, nonattenders had higher viral loads, were less likely to be virologically suppressed, had lower CD4 counts, had higher depressive symptoms, life chaos, lower quality of life, and higher rates of food insecurity, and recent drug use. Additionally, nonattenders compared with regular attenders had lower physician relationship ratings, had lower medical information clarity and more often reported transportation as a barrier to clinic attendance. When viewed as a syndemic, compared with patients not reporting any barriers, patients with 3 or more individual-level barriers were more likely to have a detectable viral load (odds ratio = 3.60, 95% CI: 1.71 to 7.61). Our findings suggest that patients presenting to the clinic with multiple barriers should be prioritized for assistance and future interventions to improve retention in care. Interventions should address multiple individual and system-level barriers simultaneously with particular attention to addressing depressive symptoms, organizational skills, relationship with the physician, and HIV-related health education.
authors: *Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL; †Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; ‡School of Nursing and Health Studies, University of Miami, Coral Gables, FL; §Florida Department of Health in Miami-Dade County, Miami, FL; ‖Department of Public Health Sciences, Biostatistics Division, University of Miami Miller School of Medicine, Miami, FL; and ¶Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY.
authors: Andrew J
authors: AJ
authors: Wawrzyniak
authors: Allan E
authors: AE
authors: Rodríguez
authors: Anthony E
authors: AE
authors: Falcon
authors: Anindita
authors: A
authors: Chakrabarti
authors: Alexa
authors: A
authors: Parra
authors: Jane
authors: J
authors: Park
authors: Kathleen
authors: K
authors: Mercogliano
authors: Kira
authors: K
authors: Villamizar
authors: Michael A
authors: MA
authors: Kolber
authors: Daniel J
authors: DJ
authors: Feaster
authors: Lisa R
authors: LR
authors: Metsch
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D000328:Adult; D018791:CD4 Lymphocyte Count; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D005260:Female; D005431:Florida / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000628:therapy; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D011788:Quality of Life; D019562:Viral Load