Positive Influences: Understanding Multilevel Factors Contributing to Women’s Entry, Engagement, and Adherence to HIV Treatment and Care

Paula Frew, PhD,MA,MPH1,2,3; Marcia Holstad, PhD, RN-C, FNP, FAANP, FAAN4; Julie Zuniga, PhD, RN4; Nikia Braxton, MPH1,2; Eleanor Sarkodie1,2, MPH, Hayley Robinett1, Jay Schamel1, Yunmi Chung, MPH1; Gina Wingood, ScD, MPH2; Igho Ofotokun, MD, MS1

1Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases; 2Emory Rollins School of Public Health, Department of Behavioral Science and Health Education; 3Emory Rollins School of Public Health, Hubert Department of Global Health; 4Emory Nell Hodgson School of Nursing

Introduction• Women liv ing with HIV face unique barriers to HIV treatment, affecting their

ability to reach HIV Continuum of Care (CC).• Improve understanding of intersectional, multilevel factors impacting both

successes and challenges in the HIV Care Continuum for HIV+ women.• Develop interventional approaches for specific groups: care-engaged,care-

inconsistent, care-detached.

Methods• Purposeful sampling strategy of women enrolled in Atlanta WIHS (N=33)

included those:

1. Newly Linked to Care/”Treatment Naïve”: newly diagnosed within the previous 90 days and are new to treatment and care;

2. Engaged in Care: ≥2 CD4 and VL tests in 12 months; and3. Retained in Care: ≥2 vis its for routine HIV care in 12 months

Qualitative: Constant comparative analyses with thematic elic itationQuantitative: Descriptive analyses, measures of association, t tests

Production of a three group behavioral typology:1. “Care-engaged”: Reported high treatment and care adherence typically with ≥2 vis its for routine HIV care for 12 months or more2. “Care-inconsistent”: Reported inconsistent provider v is its and CD4 and VL tests within a 12 month period3. “Care-detached”: Those who reported recent diagnosis in past 90 days, no provider v is its s ince diagnosis, and/or are ARV “treatment naïve”

Mixed Methods Results• Care-engaged women (N=18) described positive healthcare experience, prompt linkage to care, strong social and

healthcare provider relationships, and high CD4 (≥ 800) and suppressed viral load value post-diagnosis.

• Care-inconsistentwomen (N=9) described challenges related to housing, unsupportive healthcare institutions, and perceived HIV stigma as barriers to care. Supportive healthcare providers and institutions, social and emotional support, and viral suppression within 6 months of treatment were c ited as care facilitators, with healthcare provider insistence as a frequently c ited intervention for entering treatment.

• Care-detached women (N=6) described unstable housing, unsupportive healthcare institutions, and drug and alcohol abuse as challenges to care. Supportive social groups and healthcare providers, community-based programs, support groups and mental health services, and knowledge of HIV and HIV treatment were c ited as care facilitators.

• 48.3% of all women showed an increased CD4 count by >10% between their 1st and 2nd clinic v is it.• 44.4% of all women showed an increased CD4 count by>10% between their 1st and 3rd clinic v is it.

• Care-engaged: 37.5% showed an increased CD4 count by >10% between 1st and 2nd vis it and 40% showed an increased CD4 count between 1st and 3rd vis it.

• Care-inconsistent: 62.5% showed an increased CD4 count by >10% between 1st and 2nd vis it and 75% showed an increased CD4 count by >10% between their 1st and 3rd vis it.

• Care-detached: 60% showed an increased CD4 count by >10% between 1st and 2nd vis it and 25% showed an increased CD4 count by >10% between 1st and 3rd vis it.

Qualitative Results: (Im)Balance of Factors

Summary and Conclusions• Women face structural, social, and individual challenges that threaten care continuum outcomes.• Lab values demonstrate improvements for “Care-Inconsistent” and “Care-Detached” groups once in WIHS• Ever present across-group challenge: substance abuse.• Fewer positive and more negative experiences (with providers, stigma/discrimination, accessing meds) and housing

challenges were more common as women were more detached from care.• Common care facilitators among all three care groups: mental health services, supportive hospital staff, relationship

with provider, and healthy lab values.• Need for group-specific (as well as cross-continuum) interventions.

Funding providedbyWIHSU01AI10348(Ofotokun/Wingood) andCFAR03(Frew).

Care-Engaged

Care-Inconsistent

Care-Detached

“I love Dr ***, he’s the cat’s meow. He has a passion for what he is

doing and its infectious.”

“I quit drinking. I used to drink liquor and beer, but I quit for me to

take my medicine.”

“…make it c lear why I can’t take medicine...that make me think ok

they ain’t telling me something. Something else is going on and

they’re not telling me.”

“I take Atripla…I been got drunk and forgot to take my medicine.”

“I don’t know what I’m supposed to do. I don’t know if I’m

supposed to take meds…”

“I got my medicine on February 4, 2008 and I started taking it…I kept drinking...I still did drugs, I

still smoked crack.”