Critical, and not functional, health literacy is associated with missed HIV clinic visits in adults and older adults living with HIV in the Deep South

ABSTRACT

Engagement in care is a key component of the HIV treatment cascade and is influenced by biopsychosocial factors. Little is known about the association of health literacy with this impactful outcome in people living with HIV (PLWH). Ninety-five PLWH completed a comprehensive battery including health literacy measures covering several domains (i.e., numeracy, reading, self-efficacy, and ability to appraise and access health information). Engagement in care was operationalized as missed clinic visits (i.e., proportion of clinic visits in the prior 24 months where the participant did not attend and did not cancel or reschedule). The ability to appraise health information (measured by the Newest Vital Sign [NVS]) was the only significant health literacy predictor of missed clinic visits. Hierarchical linear regression including clinico-demographics and all health literacy variables showed that age, depression, neurocognition, and NVS were significant (p < 0.05) correlates of missed clinic visits. The ability to appraise health information was a strong and independent predictor of missed clinic visits in PLWH, even in the context of traditional correlates. Such measures may be useful in identifying PLWH with low health literacy who may be at risk for poorer engagement in care. Future research developing interventions targeting this health literacy dimension are warranted.

KEYWORDS:

• Health literacy
• visit adherence
• retention in care

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by NIH/NIMH (grant number 1R01MH106366-01A1; Vance, P.I.) and NIH/NIA (grant number R00AG048762; Fazeli, P.I.). The research was conducted via the NIH/NIA Edward Roybal Center (grant number 5P30AG02283814). HIV clinic data was extracted via the UAB site of the CFAR Network of Integrated Clinical Systems (CNICS) (grant number P30AI027767; grant number R24AI067039). Dr. Fazeli is also supported by (grant number L30AG045921).