US Adults Without HIV Suppression More Likely to Report Multiple Barriers to Care

US residents with human immunodeficiency virus (HIV) that is not virally suppressed are less engaged with HIV care and report more barriers to care than those whose HIV is virally suppressed. The findings, initially published online ahead of print, will appear in the September/October issue of the Journal of the Association of Nurses in AIDS Care.

“These findings underscore the importance of addressing barriers to care, particularly among people who are not virally suppressed,” wrote study lead author Sharoda Dasgupta, PhD, MPH, and colleagues at the Centers for Disease Control and Prevention.

Researchers looked at care engagement among nearly 12,000 US adults with diagnosed HIV between 2015 and 2018. They were interested in how engagement in care differed by viral suppression status.

People who were not virally suppressed, they found, were less likely to be retained in HIV care. Just 57.3% of those without viral suppression were retained in care compared with 90.8% of people with HIV that was virally suppressed.

Nearly all people in the study sample reported at least one barrier to HIV care. According to the study, half cited life circumstances as an impediment to care, while about a third cited financial barriers, not feeling sick enough to take medicine, and health care providers not requesting more appointments. More than a quarter had trouble finding transportation to care.

People who were not virally suppressed were more likely to cite multiple barriers to care, researchers pointed out. Specifically, they were more likely to point to life circumstances that impeded care, problems with money or health insurance, fear or denial surrounding their HIV diagnosis, and disbelief that antiretroviral therapy could improve their health status.

“These findings demonstrate that barriers can be multifaceted; addressing barriers to care by expanding comprehensive care models in HIV care settings could improve clinical outcomes among people with HIV,” researchers advised.

Reference:
Dasgupta S, Tie Y, Beer L, Fagan J, Weiser J. Barriers to HIV care by viral suppression status among US adults with HIV: Findings from the Centers for Disease Control and Prevention medical monitoring project [published online ahead of print, 2021 Mar 19]. J Assoc Nurses AIDS Care. 2021;10.1097/JNC.0000000000000249. doi:10.1097/JNC.0000000000000249