Healthcare Empowerment and HIV Viral Control: Mediating Roles of Adherence and Retention in Care

Tracey E. Wilson, Emma Sophia Kay, Bulent Turan, Mallory O. Johnson, Mirjam Colette Kempf, Janet M. Turan, Mardge H. Cohen, Adaora A. Adimora, Margaret Pereyra, Elizabeth T. Golub, Lakshmi Goparaju, Lynn Murchison, Gina M. Wingood, Lisa R. Metsch

Research output: Contribution to journalArticle

Abstract

Introduction: This study assessed longitudinal relationships between patient healthcare empowerment, engagement in care, and viral control in the Women's Interagency HIV Study, a prospective cohort study of U.S. women living with HIV. Methods: From April 2014 to March 2016, four consecutive 6-month visits were analyzed among 973 women to assess the impact of Time 1 healthcare empowerment variables (Tolerance for Uncertainty and the state of Informed Collaboration Committed Engagement) on Time 2 reports of ≥95% HIV medication adherence and not missing an HIV primary care appointment since last visit; and on HIV RNA viral control across Times 3 and 4, controlling for illicit drug use, heavy drinking, depression symptoms, age, and income. Data were analyzed in 2017. Results: Adherence of ≥95% was reported by 83% of women, 90% reported not missing an appointment since the last study visit, and 80% were categorized as having viral control. Logistic regression analyses revealed a significant association between the Informed Collaboration Committed Engagement subscale and viral control, controlling for model covariates (AOR=1.08, p=0.04), but not for the Tolerance for Uncertainty subscale and viral control (AOR=0.99, p=0.68). In separate mediation analyses, the indirect effect of Informed Collaboration Committed Engagement on viral control through adherence (β=0.04, SE=0.02, 95% CI=0.02, 0.08), and the indirect effect of Informed Collaboration Committed Engagement on viral control through retention (β=0.01, SE=0.008, 95% CI=0.001, 0.030) were significant. Mediation analyses with Tolerance for Uncertainty as the predictor did not yield significant indirect effects. Conclusions: The Informed Collaboration Committed Engagement healthcare empowerment component is a promising pathway through which to promote engagement in care among women living with HIV.

Original languageEnglish (US)
Pages (from-to)756-764
Number of pages9
JournalAmerican journal of preventive medicine
Volume54
Issue number6
DOIs
StatePublished - Jun 2018

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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    Wilson, T. E., Kay, E. S., Turan, B., Johnson, M. O., Kempf, M. C., Turan, J. M., Cohen, M. H., Adimora, A. A., Pereyra, M., Golub, E. T., Goparaju, L., Murchison, L., Wingood, G. M., & Metsch, L. R. (2018). Healthcare Empowerment and HIV Viral Control: Mediating Roles of Adherence and Retention in Care. American journal of preventive medicine, 54(6), 756-764. https://doi.org/10.1016/j.amepre.2018.02.012