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

School of Public Health

Dr. Janet Turan, professor in the department of health care organization and policy at the University of Alabama School of Public Health worked with a team of researchers to examine healthcare empowerment and HIV control. 

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.

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 percent 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.

Adherence of ≥95 percent was reported by 83 percent of women, 90 percent reported not missing an appointment since the last study visit, and 80 percent 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 percent 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 percent CI=0.001, 0.030) were significant. Mediation analyses with Tolerance for Uncertainty as the predictor did not yield significant indirect effects.

The authors concluded that the Informed Collaboration Committed Engagement healthcare empowerment component is a promising pathway through which to promote engagement in care among women living with HIV.

Full article.