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

Introduction: 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. Methods: 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% 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. Results: Adherence of ≥95% was reported by 83% of women, 90% reported not missing an appointment since the last study visit, and 80% 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% 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% CI=0.001, 0.030) were significant. Mediation analyses with Tolerance for Uncertainty as the predictor did not yield significant indirect effects. Conclusions: The Informed Collaboration Committed Engagement healthcare empowerment component is a promising pathway through which to promote engagement in care among women living with HIV

Supplementary Material for: Chromosome Evolution in Dendropsophini (Amphibia, Anura, Hylinae)

Dendropsophini is the most species-rich tribe within Hylidae with 234 described species. Although cytogenetic information is sparse, chromosome numbers and morphology have been considered as an important character system for systematic inferences in this group. Using a diversity of standard and molecular techniques, we describe the previously unknown karyotypes of the genera <i>Xenohyla</i>, <i>Scarthyla</i> and <i>Sphaenorhynchus</i> and provide new information on <i>Dendropsophus</i> and<i> Lysapsus</i>. Our results reveal significant karyotype diversity among Dendropsophini, with diploid chromosome numbers ranging from 2n = 22 in <i>S. goinorum</i>, 2n = 24 in <i>Lysapsus</i>, <i>Scinax</i>, <i>Xenohyla</i>, and almost all species of <i>Sphaenorhynchus</i> and <i>Pseudis</i>, 2n = 26 in <i>S.</i><i>carneus</i>, 2n = 28 in <i>P.</i><i>cardosoi</i>, to 2n = 30 in all known <i>Dendropsophus</i> species. Although nucleolar organizer regions (NORs) and C-banding patterns show a high degree of variability, NOR positions in 2n = 22, 24 and 28 karyotypes and C-banding patterns in <i>Lysapsus</i> and <i>Pseudis</i> are informative cytological markers. Interstitial telomeric sequences reveal a diploid number reduction from 24 to 22 in <i>Scarthyla</i> by a chromosome fusion event. The diploid number of <i>X.</i><i>truncata</i> corroborates the character state of 2n = 30 as a synapomorphy of <i>Dendropsophus</i>