title: The Influence of Trust in Physicians and Trust in the Healthcare System on Linkage, Retention, and Adherence to HIV Care.
abstract: Lack of trust by the patient in the physicians or the healthcare system has been associated with poorer health outcomes. The present study was designed to determine if trust in physicians and the healthcare system among persons newly diagnosed with HIV infection was predictive of patients' subsequent linkage, retention, and adherence to HIV care. 178 newly diagnosed HIV infected patients were administered the trust-in-physicians and trust-in-healthcare system scales. Median trust-in-physicians and trust-in-healthcare system scores were compared for all the mentioned subsequent linkage, retention, and adherence to HIV care. Univariate logistic regression using the trust-in-physician scale confirmed significant association with retention in care (p = 0.04), which persisted in multivariate analyses (p = 0.04). No significant association was found between trust-in-physicians and linkage to care or adherence to antiretroviral therapy. Trust in the healthcare system was not associated with any of the outcomes. Patients with higher trust in physicians were more likely to be retained in HIV care. Trust at diagnosis may not be a barrier to better clinical outcomes, either because trust changes based on subsequent interactions, or because trust is not a determining feature. Interventions to improve retention in care could include improving trust in physicians or target persons with low trust in physicians.
authors.affiliation: 1 Legacy Community Health Services , Houston, Texas.
authors.forename: James L
authors.initials: JL
authors.lastname: Graham
authors.affiliation: 2 The Department of Medicine, Baylor College of Medicine , Houston, Texas.|3 The Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center , Houston, Texas.
authors.forename: Lokesh
authors.initials: L
authors.lastname: Shahani
authors.affiliation: 4 The University of Texas Health Science Center at Houston Medical School , Houston, Texas.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Grimes
authors.affiliation: 3 The Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center , Houston, Texas.
authors.forename: Christine
authors.initials: C
authors.lastname: Hartman
authors.affiliation: 2 The Department of Medicine, Baylor College of Medicine , Houston, Texas.|3 The Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey VA Medical Center , Houston, Texas.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Giordano
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D001294:Attitude to Health; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000523:psychology; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010820:Physicians; D011446:Prospective Studies; D035502:Trust; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents