Predictors of disparities in retention in care among African Americans living with HIV

ABSTRACT

Limited health literacy may contribute to racial disparities in retention in HIV care. The purpose of this study was to evaluate the effects of health literacy and patient and social-level factors on retention in care among African Americans living with HIV. This study included 699 participants recruited from outpatient HIV clinics and retention in care was defined as visit adherence. Multivariable logistic regression models were used to assess predictors of visit adherence among persons with 100% visit adherence compared to less than 100% visit adherence. Controlling for demographic factors, the odds of 100% visit adherence was greater among non-African Americans compared to African Americans. In models that included health literacy, race was no longer significant and health literacy was a significant predictor of 100% visit adherence. Among participants with less than 100% visit adherence, health literacy was not a significant predictor of visit adherence; however, age, marital status, and patient attitudes towards the health care provider were significant predictors. Findings suggest that health literacy may mediate the relationship between race and visit adherence. Future studies should further examine these relationships and develop interventions that target modifiable factors, with a goal of improving health equity and minimizing disparities.

KEYWORDS:

• health literacy
• retention in care
• visit adherence
• disparities in HIV

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings from this study are available on request from the corresponding author (AA). The data are not publicly available due to information that could compromise the privacy of research participants.

Additional information

Funding

This study was funded by the National Institute of Nursing Research and the National Institute of Mental Health under the following award numbers [F31 NR017580, R01 MH092284, P30 NR014134, T32NR012715]. This work was also supported by the Center for AIDS Research at Emory University [P30AI050409].