Login Register Cart 0
Generic placeholder image

Current HIV Research

Editor-in-Chief

ISSN (Print): 1570-162X
ISSN (Online): 1873-4251

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Healthcare Utilization, Unmet Service Needs, and Medication Adherence Among People Living with HIV/AIDS

Author(s): Xiangjun Zhang, Roy F. Oman*, Trudy A. Larson, Elizabeth J. Christiansen, Michelle L. Granner, Minggen Lu and Yueran Yang

Volume 18, Issue 6, 2020

Page: [436 - 442] Pages: 7

DOI: 10.2174/1570162X18666200817112255

Price: $65

Abstract

Background: Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on antiretroviral therapy (ART) adherence are not well understood. The purpose of this study was to investigate associations among PLWHA’s service utilization, unmet service needs, and ART adherence.

Methods: PLWHA (N=162) 18 years or older were recruited from a Nevada statewide needs assessment project in 2016. Participants completed a self-administered questionnaire on paper or online. The independent variables were service utilization and unmet service needs. The outcome variable was ART adherence. Multivariable logistic regression analyses were conducted to examine associations between the amount of utilized services and unmet service needs with ART adherence.

Results: Only 12 (7.5%) participants reported they received all the needed services. The ART nonadherence group showed significantly higher unmet medical service needs compared to the ART adherence group (p=0.007). Unmet medical service needs (Adjusted Odds Ratio (AOR) 0.69, CI 0.53-0.90) and unmet support service needs (AOR 0.68, CI 0.48-0.97) were negatively associated with ART adherence. However, utilizing medical services (AOR 1.06, CI 0.87-1.30) and support services (AOR 0.88, CI 0.74-1.04) in the current year were not significantly associated with ART adherence.

Conclusion: The results of this study indicate that health promotion programming should focus not only on introducing new services at the community level, but also work to optimize the availability and awareness of current services. Furthermore, health promotion programs should focus on filling service coverage gaps and improving the facilitation of services.

Keywords: HIV/AIDS, service utilization, service needs, medication adherence, medical service, support service.

« Previous Next »
Graphical Abstract

[1]
Crum NF, Riffenburgh RH, Wegner S, et al. Triservice AIDS Clinical Consortium. Comparisons of causes of death and mortality rates among HIV-infected persons: analysis of the pre-, early, and late HAART (highly active antiretroviral therapy) eras. J Acquir Immune Defic Syndr 2006; 41(2): 194-200.
[http://dx.doi.org/10.1097/01.qai.0000179459.31562.16] [PMID: 16394852]
[2]
Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 2009; 338: a3172.
[http://dx.doi.org/10.1136/bmj.a3172] [PMID: 19171560]
[3]
Das M, Chu PL, Santos G-M, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One 2010; 5(6)e11068
[http://dx.doi.org/10.1371/journal.pone.0011068] [PMID: 20548786]
[4]
Centers for Disease Control and Prevention. HIV Treatment as Prevention https://www.cdc.gov/hiv/risk/art/index.html2018.
[5]
Bradley H, Hall HI, Wolitski RJ, et al. Vital Signs: HIV diagnosis, care, and treatment among persons living with HIV-United States, 2011. MMWR Morb Mortal Wkly Rep 2014; 63(47): 1113-7.
[PMID: 25426654]
[6]
Ford N, Darder M, Spelman T, Maclean E, Mills E, Boulle A. Early adherence to antiretroviral medication as a predictor of long-term HIV virological suppression: five-year follow up of an observational cohort. PLoS One 2010; 5(5)e10460
[http://dx.doi.org/10.1371/journal.pone.0010460] [PMID: 20485480]
[7]
The White House. National HIV/AIDS strategy for the United States https://files.hiv.gov/s3fs-public/nhas-update.pdf2018.
[8]
Montaner JSG, Lima VD, Harrigan PR, et al. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the “HIV Treatment as Prevention” experience in a Canadian setting. PLoS One 2014; 9(2)e87872
[http://dx.doi.org/10.1371/journal.pone.0087872] [PMID: 24533061]
[9]
Harrison KM, Song R, Zhang X. Life expectancy after HIV diagnosis based on national HIV surveillance data from 25 states, United States. J Acquir Immune Defic Syndr 2010; 53(1): 124-30.
[http://dx.doi.org/10.1097/QAI.0b013e3181b563e7] [PMID: 19730109]
[10]
Jelsma J, Maclean E, Hughes J, Tinise X, Darder M. An investigation into the health-related quality of life of individuals living with HIV who are receiving HAART. AIDS Care 2005; 17(5): 579-88.
[http://dx.doi.org/10.1080/09540120412331319714] [PMID: 16036244]
[11]
Sackoff JE, Hanna DB, Pfeiffer MR, Torian LV. Causes of death among persons with AIDS in the era of highly active antiretroviral therapy: New York City. Ann Intern Med 2006; 145(6): 397-406.
[http://dx.doi.org/10.7326/0003-4819-145-6-200609190-00003] [PMID: 16983127]
[12]
Adih WK, Selik RM, Hall HI, Babu AS, Song R. Associations and trends in cause-specific rates of death among persons reported with HIV infection, 23 US jurisdictions, through 2011. Open AIDS J 2016; 10: 144-57.
[http://dx.doi.org/10.2174/1874613601610010144] [PMID: 27708746]
[13]
Messeri P, Lee G, Berk S. Prevalence of Chronic Diseases & Comorbid Conditions in the CHAIN Cohort of PLWHA. Columbia University 2009.
[14]
Ward BW, Schiller JS, Goodman RA. Peer reviewed: Multiple chronic conditions among us adults: A 2012 update. Prev Chronic Dis 2014; 11.
[15]
Balderson BH, Grothaus L, Harrison RG, McCoy K, Mahoney C, Catz S. Chronic illness burden and quality of life in an aging HIV population. AIDS Care 2013; 25(4): 451-8.
[http://dx.doi.org/10.1080/09540121.2012.712669] [PMID: 22894702]
[16]
Brennan-Ing M, Seidel L, Rodgers L, et al. The impact of comprehensive case management on HIV client outcomes. PLoS One 2016; 11(2)e0148865
[http://dx.doi.org/10.1371/journal.pone.0148865] [PMID: 26849561]
[17]
Wilson MG, Husbands W, Makoroka L, et al. Counselling, case management and health promotion for people living with HIV/AIDS: an overview of systematic reviews. AIDS Behav 2013; 17(5): 1612-25.
[http://dx.doi.org/10.1007/s10461-012-0283-1] [PMID: 22961581]
[18]
Aidala AA, Wilson MG, Shubert V, et al. Housing status, medical care, and health outcomes among people living with HIV/AIDS: a systematic review. Am J Public Health 2016; 106(1): e1-e23.
[http://dx.doi.org/10.2105/AJPH.2015.302905] [PMID: 26562123]
[19]
Goswami ND, Schmitz MM, Sanchez T, et al. Understanding local spatial variation along the care continuum: the potential impact of transportation vulnerability on HIV linkage to care and viral suppression in high-poverty areas, Atlanta, Georgia. J Acquir Immune Defic Syndr 2016; 72(1): 65-72.
[http://dx.doi.org/10.1097/QAI.0000000000000914] [PMID: 26630673]
[20]
Sagrestano LM, Clay J, Finerman R, Gooch J, Rapino M. Transportation vulnerability as a barrier to service utilization for HIV- positive individuals. AIDS Care 2014; 26(3): 314-9.
[http://dx.doi.org/10.1080/09540121.2013.819403] [PMID: 23876086]
[21]
Springer SA, Dushaj A, Azar MM. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: a systematic review. AIDS Behav 2012; 16(8): 2119-43.
[http://dx.doi.org/10.1007/s10461-012-0212-3] [PMID: 22644066]
[22]
Gonzalez A, Barinas J, O’Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep 2011; 8(4): 223-34.
[http://dx.doi.org/10.1007/s11904-011-0093-5] [PMID: 21858414]
[23]
Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr 2011; 58(2): 181-7.
[http://dx.doi.org/10.1097/QAI.0B013E31822D490A] [PMID: 21857529]
[24]
Pence BW, Gaynes BN, Adams JL, et al. The effect of antidepressant treatment on HIV and depression outcomes: results from a randomized trial. AIDS 2015; 29(15): 1975-86.
[http://dx.doi.org/10.1097/QAD.0000000000000797] [PMID: 26134881]
[25]
Walley AY, Palmisano J, Sorensen-Alawad A, et al. Engagement and substance dependence in a primary care-based addiction treatment program for people infected with HIV and people at high-risk for HIV infection. J Subst Abuse Treat 2015; 59: 59-66.
[http://dx.doi.org/10.1016/j.jsat.2015.07.007] [PMID: 26298399]
[26]
Korhonen LC, DeGroote NP, Shouse RL, Valleroy LA, Prejean J, Bradley H. Unmet needs for ancillary services among Hispanics/Latinos receiving HIV medical care—United States, 2013–2014. MMWR Morb Mortal Wkly Rep 2016; 65(40): 1104-7.
[http://dx.doi.org/10.15585/mmwr.mm6540a3] [PMID: 27736837]
[27]
DeGroote NP, Korhonen LC, Shouse RL, Valleroy LA, Bradley H. Unmet needs for ancillary services among men who have sex with men and who are receiving HIV medical care—United States, 2013–2014. MMWR Morb Mortal Wkly Rep 2016; 65(37): 1004-7.
[http://dx.doi.org/10.15585/mmwr.mm6537a4] [PMID: 27657489]
[28]
Lennon CA, Pellowski JA, White AC, et al. Service priorities and unmet service needs among people living with HIV/AIDS: results from a nationwide interview of HIV/AIDS housing organizations. AIDS Care 2013; 25(9): 1083-91.
[http://dx.doi.org/10.1080/09540121.2012.749337] [PMID: 23305552]
[29]
Reif S, Whetten K, Lowe K, Ostermann J. Association of unmet needs for support services with medication use and adherence among HIV-infected individuals in the southeastern United States. AIDS Care 2006; 18(4): 277-83.
[http://dx.doi.org/10.1080/09540120500161868] [PMID: 16809104]
[30]
Maciel RA, Klück HM, Durand M, Sprinz E. Comorbidity is more common and occurs earlier in persons living with HIV than in HIV-uninfected matched controls, aged 50 years and older: A cross-sectional study. Int J Infect Dis 2018; 70: 30-5.
[http://dx.doi.org/10.1016/j.ijid.2018.02.009] [PMID: 29476902]
[31]
Beer L, Mattson CL, Bradley H, Skarbinski J. Medical Monitoring Project. Understanding cross-sectional racial, ethnic, and gender disparities in antiretroviral use and viral suppression among HIV patients in the United States. Medicine (Baltimore) 2016; 95(13)e3171
[http://dx.doi.org/10.1097/MD.0000000000003171] [PMID: 27043679]
[32]
Horberg MA, Hurley LB, Klein DB, et al. The HIV care cascade measured over time and by age, sex, and race in a large national integrated care system. AIDS Patient Care STDS 2015; 29(11): 582-90.
[http://dx.doi.org/10.1089/apc.2015.0139] [PMID: 26505968]
[33]
Kyser M, Buchacz K, Bush TJ, et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care 2011; 23(5): 601-11.
[http://dx.doi.org/10.1080/09540121.2010.525603] [PMID: 21293992]
[34]
Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health 2007; 97(12): 2238-45.
[http://dx.doi.org/10.2105/AJPH.2006.090209] [PMID: 17971562]
[35]
Centers for Disease Control and Prevention. HIV treatment and care https://www.cdc.gov/hiv/clinicians/treatment/treatment-clinicians.html2020.
[36]
Kalichman SC, Kalichman MO, Cherry C. Forget about forgetting: structural barriers and severe non-adherence to antiretroviral therapy. AIDS Care 2017; 29(4): 418-22.
[http://dx.doi.org/10.1080/09540121.2016.1220478] [PMID: 27535297]
[37]
Shubber Z, Mills EJ, Nachega JB, et al. Patient-reported barriers to adherence to antiretroviral therapy: a systematic review and meta-analysis. PLoS Med 2016; 13(11)e1002183
[http://dx.doi.org/10.1371/journal.pmed.1002183] [PMID: 27898679]
[38]
Hodgson I, Plummer ML, Konopka SN, et al. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS One 2014; 9(11)e111421
[http://dx.doi.org/10.1371/journal.pone.0111421] [PMID: 25372479]
[39]
Singer AW, Weiser SD, McCoy SI. Does food insecurity undermine adherence to antiretroviral therapy? A systematic review. AIDS Behav 2015; 19(8): 1510-26.
[http://dx.doi.org/10.1007/s10461-014-0873-1] [PMID: 25096896]
[40]
Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc 2013; 16(3)(Suppl. 2): 18640.
[http://dx.doi.org/10.7448/IAS.16.3.18640] [PMID: 24242258]
[41]
Kalichman S, Kalichman MO, Cherry C. Medication beliefs and structural barriers to treatment adherence among people living with HIV infection. Psychol Health 2016; 31(4): 383-95.
[http://dx.doi.org/10.1080/08870446.2015.1111371] [PMID: 26534788]
[42]
Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother 2009; 63(4): 636-40.
[http://dx.doi.org/10.1093/jac/dkp006] [PMID: 19153077]
[43]
Surratt HL, O’Grady CL, Levi-Minzi MA, Kurtz SP. Medication adherence challenges among HIV positive substance abusers: the role of food and housing insecurity. AIDS Care 2015; 27(3): 307-14.
[http://dx.doi.org/10.1080/09540121.2014.967656] [PMID: 25314042]
[44]
Kalichman SC, Hernandez D, Cherry C, Kalichman MO, Washington C, Grebler T. Food insecurity and other poverty indicators among people living with HIV/AIDS: effects on treatment and health outcomes. J Community Health 2014; 39(6): 1133-9.
[http://dx.doi.org/10.1007/s10900-014-9868-0] [PMID: 24705680]
[45]
Feldman MB, Alexy ER, Thomas JA, Gambone GF, Irvine MK. The association between food insufficiency and HIV treatment outcomes in a longitudinal analysis of HIV-infected individuals in New York City. J Acquir Immune Defic Syndr 2015; 69(3): 329-37.
[http://dx.doi.org/10.1097/QAI.0000000000000596] [PMID: 25751230]
[46]
Leaver CA, Bargh G, Dunn JR, Hwang SW. The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav 2007; 11(6)(Suppl.): 85-100.
[http://dx.doi.org/10.1007/s10461-007-9246-3] [PMID: 17682940]
[47]
Centers for Disease Control and Prevention. HIV: economically disadvantaged https://www.cdc.gov/hiv/group/poverty.html2019.
[48]
Holtgrave DR, Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States. Sex Transm Infect 2003; 79(1): 62-4.
[http://dx.doi.org/10.1136/sti.79.1.62] [PMID: 12576618]
[49]
Cahill SR, Mayer KH, Boswell SL. The Ryan White HIV/AIDS program in the age of health care reform. Am J Public Health 2015; 105(6): 1078-85.
[http://dx.doi.org/10.2105/AJPH.2014.302442] [PMID: 25880940]
[50]
Bernard S, Tailor A, Jones P, Alexander DE. Addressing the medical and support service needs of people living with HIV (PLWH) through program collaboration and service integration (PCSI). Calif J Health Promot 2016; 14(1): 1-14.
[http://dx.doi.org/10.32398/cjhp.v14i1.1860] [PMID: 28217034]

Rights & Permissions Print Cite
Article Metrics
24
© 2024 Bentham Science Publishers | Privacy Policy