Andrew J. Wawrzyniak|Allan Rodríguez|Anthony E. Falcon|Anindita Chakrabarti|Alexa Parra|Jane Park|Kathleen Mercogliano|Kira Villamizar|Michael A. Kolber|Daniel J. Feaster|Lisa R. Metsch
Association of Individual and Systemic Barriers to Optimal Medical Care in People Living With HIV/AIDS in Miami-Dade County
University of Miami|Miami Dade College|Florida Department of Health|University of Miami|University of Miami|University of Miami|University of Miami|University of Miami|University of Miami|Florida Department of Health|Miami Dade College|University of Miami|University of Miami|Columbia University
barriers retention hiv care detrimental patients progress along hiv continuum care previous literature focused individual clientlevel barriers interventions address contrast less work examined role systemlevel barriers hiv care outcomes study seeks understand individual systemic barriers individually associated clinic appointment attendance virologic suppression hivinfected patients attending largest hiv clinic miamidade fl addition examined synergistic effects barriers potential syndemic factors health outcomes barriers clinic attendance determined facetoface study interview 444 hivinfected outpatients 187 regular attenders 191 irregular attenders 66 nonattenders identified electronic medical records compared attendance groups nonattenders higher viral loads less likely virologically suppressed lower cd4 counts higher depressive symptoms life chaos lower quality life higher rates food insecurity recent drug use additionally nonattenders compared regular attenders lower physician relationship ratings lower medical information clarity often reported transportation barrier clinic attendance viewed syndemic compared patients reporting barriers patients 3 individuallevel barriers likely detectable viral load odds ratio 360 95 ci 171 761 findings suggest patients presenting clinic multiple barriers prioritized assistance future interventions improve retention care interventions address multiple individual systemlevel barriers simultaneously particular attention addressing depressive symptoms organizational skills relationship physician hivrelated health education