Personal HIV Knowledge, Appointment Adherence and HIV Outcomes

Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Miami, FL, 33136, USA, .
AIDS and Behavior (Impact Factor: 3.49). 11/2012; 17(1). DOI: 10.1007/s10461-012-0367-y
Source: PubMed


HIV knowledge may impact patient access, understanding, and utilization of HIV medical information. This study explored the relationship between personal HIV knowledge, appointment adherence and treatment outcomes. HIV-infected individuals (n = 210) were assessed on factors related to HIV knowledge and appointment adherence. Adherence data and laboratory values were extracted from medical records. HIV knowledge was measured by participants' knowledge of their CD4 count and viral load (VL) and adherence was defined as attendance at >75 % of appointments. Two-thirds of participants were adherent, but only one-third knew their CD4 count and VL. Controlling for time since last appointment, HIV knowledge more than doubled the odds of appointment adherence. In combination with relationship with provider, knowledge predicted increased CD4 count and increased odds of an undetectable VL by almost five times. Personal HIV knowledge may be a valuable indicator of engagement in care and may also facilitate improved treatment outcomes.

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    • "Health literacy can be defined as " the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions " (The Patient Protection and Affordable Care Act, 2010). Low health literacy is evident in approximately 20-40% of individuals living with HIV infection (Kalichman & Rompa, 2000) and can be associated with reduced engagement in healthcare (Jones et al., 2013), non-adherence to antiretroviral therapies (ART) (Jones et al., 2013; Kalichman et al., 1999) and poorer HIV disease outcomes (Kalichman & Rompa, 2000). The Internet plays an increasingly critical role in the health literacy and healthcare of persons living with HIV disease, approximately 50% of whom use the Internet for healthcare purposes (Dorner et al., 2014; Thomas & Shuter, 2010) HIV+ individuals' use of health-related internet resources, such as navigating the World Wide Web (WWW) to obtain essential health-related information (e.g., disease symptoms, and manage their healthcare (e.g., online pharmacy refills), is associated with better general health status (Kalichman et al., 2005; Schnall et al., 2014). "
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    ABSTRACT: This study evaluated the effects of HIV-associated Neurocognitive Disorders (HAND) on 2 Internet-based tests of healthcare management. Study participants included 46 individuals with HIV infection, 19 of whom were diagnosed with HAND, and 21 seronegatives. Participants were administered Internet-based tests of online pharmacy and health records navigation skills in which they used mock credentials to log in to an experimenter-controlled website and independently perform a series of typical online health-related behaviors (e.g., refill a prescription, read and interpret an electronic chart note). HAND was associated with significantly lower accuracy on both the online pharmacy and health records navigation tasks. Among the HIV+ participants, poorer performance on the online healthcare navigation tasks was associated with fewer years of education, higher plasma viral load, less frequent Internet use, and lower health literacy. Findings indicate that individuals with HAND may have marked difficulties navigating the Internet to complete important health-related behaviors.
    No preview · Article · Nov 2015 · Archives of Clinical Neuropsychology
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    • "These relationships demonstrate the positive impact of insurance with medication coverage on appointment keeping behavior and underscore the need for provision of more transparent information regarding prescription costs. These findings are consistent with studies that have demonstrated a relationship between appointment non-adherence and greater insurance copays, living in a poverty area [2], lower income [32], and lower socioeconomic class [33]. Participants reported that inadequate patient transportation to appointments and forgetfulness were barriers to healthcare; these relationships have also been corroborated elsewhere [34]–[36]. "
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    ABSTRACT: Background: Missed appointments are associated with an increased risk of hospitalization and mortality. Despite its widespread prevalence, little data exists regarding factors related to appointment non-adherence among hypertensive African-Americans. Objective: To investigate factors associated with appointment non-adherence among African-Americans with severe, poorly controlled hypertension. Design and Participants: A cross-sectional survey of 185 African-Americans admitted to an urban medical center in Maryland, with severe, poorly controlled hypertension from 1999–2004. Categorical and continuous variables were compared using chi-square and t-tests. Adjusted multivariable logistic regression was used to assess correlates of appointment non-adherence. Main Outcome Measures: Appointment non-adherence was the primary outcome and was defined as patient-report of missing greater than 3 appointments out of 10 during their lifetime.ResultsTwenty percent of participants (n = 37) reported missing more than 30% of their appointments. Patient characteristics independently associated with a higher odds of appointment non-adherence included not finishing high school (Odds ratio [OR] = 3.23 95% confidence interval [CI] (1.33–7.69), hypertension knowledge ([OR] = 1.20 95% CI: 1.01–1.42), lack of insurance ([OR] = 6.02 95% CI: 1.83–19.88), insurance with no medication coverage ([OR] = 5.08 95% CI: 1.05–24.63), cost of discharge medications ([OR] = 1.20 95% CI: 1.01–1.42), belief that anti-hypertensive medications do not work ([OR] = 3.67 95% CI: 1.16–11.7), experience of side effects ([OR] = 3.63 95% CI: 1.24–10.62), medication non-adherence ([OR] = 11.31 95% CI: 3.87–33.10). Substance abuse was not associated with appointment non-adherence ([OR] = 1.05 95% CI: 0.43–2.57). Conclusions: Appointment non-adherence among African-Americans with poorly controlled hypertension was associated with many markers of inadequate access to healthcare, knowledge, attitudes and beliefs.
    Full-text · Article · Aug 2014 · PLoS ONE
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    ABSTRACT: Retention in care for HIV is essential for effective disease management; however, factors that may confer risk or protection for adherence to regular HIV care are less well understood. This study tested whether HIV-associated cognitive impairment (CI) and low health literacy reduced adherence to routine HIV medical and phlebotomy visits and if social support and patient-provider relationship conferred a protective effect. Participants were 210 HIV-infected patients enrolled in outpatient care and followed for 28-weeks. Results showed that those attending >75 % of phlebotomy visits were more likely to be virally suppressed. Health literacy was unassociated with adherence to medical or phlebotomy visits. CI was not directly related to medical or phlebotomy visit adherence; however those with CI and greater use of social support were less likely to miss medical visits. Utilizing social support may be an effective means of managing visit adherence, especially among patients with CI.
    Full-text · Article · Oct 2013 · AIDS and Behavior
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