If someone cares about you, you are more apt to come around: improving HIV care engagement by strengthening the patient-provider relationship.

Purpose:The patient-provider relationship is a central factor that can promote or hinder long-term engagement in care among people living with chronic illnesses. In this paper, we explore characteristics of the patient-provider relationship that facilitated or hindered engagement in care among patients receiving care at HIV specialty clinics. Patients and methods:We conducted 6 focus group discussions with a total of 43 well-retained and less well-retained HIV+ patients in San Francisco, Seattle, and Birmingham, to elicit a wide range of perspectives on engagement in HIV care. Borrowing from the field of psychotherapy, we examined patient-provider relationship characteristics through the lens of the therapeutic alliance, and with regard to their therapeutic efficacy and impact on patient engagement. Results:The majority of participants emphasized how a strong patient-provider relationship defined by trust, intimacy, and collaboration promoted engagement, while a weak patient-provider relationship impeded engagement. Conclusion:We discuss practical strategies and therapeutic techniques that may be helpful to providers in building strong patient-provider relationship and contend that a strong patient-provider relationship is crucial for patients to feel cared for during clinical encounters, which can promote long-term and sustained engagement in HIV care

Assessing readiness to implement long-acting injectable HIV antiretroviral therapy: Provider and staff perspectives

Background: Long-acting injectable antiretroviral therapy (LAI-ART) represents the next innovation in HIV therapy. Pre-implementation research is needed to develop effective strategies to ensure equitable access to LAI-ART to individuals living with HIV. Methods: We conducted focus group discussions (FGDs) with providers and staff affiliated with HIV clinics in San Francisco, Chicago, and Atlanta to understand barriers to and facilitators of LAI-ART implementation. Participants also completed a short survey about implementation intentions. FGDs were held via video conference, recorded, transcribed, and thematically analyzed using domains associated with the Consolidated Framework for Implementation Research (CFIR). Results: Between September 2020 and April 2021, we led 10 FDGs with 49 participants, of whom ~60% were prescribing providers. Organizational readiness for implementing change was high, with 85% agreeing to being committed to figuring out how to implement LAI-ART. While responses were influenced by the unique inner and outer resources available in each setting, several common themes, including implementation mechanisms, dominated: (1) optimism and enthusiasm about LAI-ART was contingent on ensuring equitable access to LAI-ART; (2) LAI-ART shifts the primary responsibility of ART adherence from the patient to the clinic; and (3) existing clinic systems require strengthening to meet the needs of patients with adherence challenges. Current systems in all sites could support the use of LAI-ART in a limited number of stable patients. Scale-up and equitable use would be challenging or impossible without additional personnel. Participants outlined programmatic elements necessary to realize equitable access including centralized tracking of patients, capacity for in-depth, hands-on outreach, and mobile delivery of LAI-ART. Sites further specified unknown logistical impacts on implementation related to billing/payer source as well as shipping and drug storage. Conclusions: Among these HIV care sites, clinic readiness to offer LAI-ART to a subset of patients is high. The main challenges to implementation include concerns about unequal access and a recognition that strengthening the clinic system is critical.</p

Minority Stress, Structural Stigma, and Physical Health among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships

Background: Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma. Purpose: To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people. Methods: Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes. Results: Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health. Conclusion: Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health

Disclosure of HIV Serostatus in Latinos as a Function of Acculturation: The Role of Attitudinal Components and the Theory of Reasoned Action

Abstract not availabl

A Diathesis-Stress Approach to Post-Traumatic Stress Disorder Symptoms Associated with an HIV Diagnosis: Implications for Medication Non-adherence.

Introduction. We fit a diathesis-stress model with childhood trauma and neuroticism as predictors of depressive and HIV-related PTSD symptomatology in a sample of HIV+ Latino men who have sex with men (MSM). We then examined the impact of depressive and HIV-related PTSD symptomatology on medication adherence. We hypothesized the primary stressor from the diathesis-stress model to be symptoms of dissociation at the time of being diagnosed with HIV. Method. We sampled 149 Latino adult MSM living with HIV at a local HIV treatment clinic in El Paso, Texas. We administered all surveys in paper-and-pencil form, with viral loads and CD4 cell counts extracted from medical charts. Specifically, data were collected on self-reported histories of childhood abuse, trait levels of neuroticism, acculturation to non-Latino culture, accumulated life stressors, depression, HIV and non HIV-related post-traumatic stress symptoms, resilience, functional impairment and medication adherence. All participants were interviewed in either English or Spanish and paid $30 for their participation. Interviews lasted approximately two hours. Results. We observed high levels of childhood sexual abuse (22%) and trauma overall, as well as high rates of mild-to-moderate symptoms of depression (30%). Self-reported medication adherence was high across all measures. We found support for our hypothesized path model as a test of the theoretical structure proposed by the diathesis-stress model. All fit indices were indicative of good model fit. In addition, we found support for the diathesis-stress interaction with dissociation symptoms at the time of diagnosis moderating the relationship between childhood trauma and HIV-related PTSD symptoms. As hypothesized, our regression analyses revealed depression to be negatively correlated with adherence. PTSD symptoms related to HIV were positively associated with adherence, the opposite direction of that hypothesized. Conclusion. The diathesis-stress framework adequately models the relationship among childhood trauma, current levels of psychological distress, and the stress of being diagnosed with HIV. Furthermore, psychological distress is negatively associated with adherence and overall quality of life. Implications for interventions are discussed