Date of Completion

8-8-2013

Embargo Period

8-8-2013

Keywords

Retention in HIV Care, Health Behavior Theory, SEM, Intervention

Major Advisor

Jeffrey D. Fisher, Ph.D.

Associate Advisor

K. Rivet Amico, Ph.D.

Associate Advisor

Blair T. Johnson, Ph.D.

Field of Study

Psychology

Degree

Doctor of Philosophy

Open Access

Open Access

Abstract

Maintaining HIV care attendance with some degree of regularity (i.e., retention in HIV care) is critical to attain optimal health outcomes for people living with HIV (PLWH) and HIV-affected communities. In the United States, approximately 50% of all PLWH who know their status are inadequately retained in HIV care once care has been initiated. Poor retention in HIV care is associated with deceased odds of viral suppression (resulting in increased risk of transmission to HIV-negative others), more rapid progression to an AIDS diagnosis, and increased odds of death. As such promoting patients’ retention in HIV care is a critical need for both individual and public health; as a means to reduce future HIV incidence, morbidity, and mortality. Efforts to understand and support the behavioral determinants involved in patients’ decisions to attend (vs. not attend) routine HIV care appointments (i.e., attending at least one HIV care appointment every 3 months) are urgently needed. Through the current work, the application of a theory-based approach to retention in HIV care was used to identify these critical determinants and understand their association with patterns of poor retention in care behaviors (Study 1). These findings were then used to design a theory-based proof-of-concept single-session intervention, 60 Minutes for Health, which was descriptively assessed in a small number of HIV-positive patients (Study 2). This theory-based approach was guided by the situated Information, Motivation, Behavioral Skills model, and was investigated among a treatment experienced inner city community clinic HIV-positive patient population in the Bronx, NY. While results are limited in speaking beyond this study population, findings reflect the timely movement towards addressing retention in HIV care as a unique individual health behavior that must be sustained over the life course of HIV, offering insights into one of the greatest treatment challenges to optimizing HIV-related health outcomes in the United States.

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