Tracey E Wilson1, Emma Sophia Kay2, Bulent Turan3, Mallory O Johnson4, Mirjam-Colette Kempf5, Janet M Turan6, Mardge H Cohen7, Adaora A Adimora8, Margaret Pereyra9, Elizabeth T Golub10, Lakshmi Goparaju11, Lynn Murchison12, Gina M Wingood9, Lisa R Metsch9. 1. Department of Community Health Sciences, State University of New York, Downstate Medical Center School of Public Health, Brooklyn, New York. Electronic address: tracey.wilson@downstate.edu. 2. School of Social Work, University of Alabama, Tuscaloosa, Alabama. 3. Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama. 4. Department of Medicine, University of California, San Francisco, California. 5. School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama. 6. School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama. 7. Department of Medicine, Stroger Hospital, Cook County Health and Hospital System, Chicago, Illinois. 8. Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 9. Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York. 10. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 11. Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia. 12. Department of Medicine, Montefiore Medical Center, Bronx, New York.
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.
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.
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