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Factors associated with lack of care engagement among older, rural-dwelling adults living with HIV in the United States. J Rural Health 2023 Mar;39(2):477-487

Date

12/10/2022

Pubmed ID

36482508

Pubmed Central ID

PMC10038837

DOI

10.1111/jrh.12732

Scopus ID

2-s2.0-85144072090 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

PURPOSE: Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50.

METHODS: We conducted a cross-sectional study to evaluate the association between patient-level factors and a combined outcome variable encompassing multiple aspects of care engagement.

FINDINGS: Either online or on paper, 446 participants completed our survey. One-third of the participants (33%) were from the southern United States; one-third were women; one-third were non-White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care.

CONCLUSIONS: Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.

Author List

Petroll AE, Quinn KG, John SA, Nigogosyan Z, Walsh JL

Authors

Steven A. John PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Andrew Petroll MD Professor in the Medicine department at Medical College of Wisconsin
Katherine Quinn PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Jennifer L. Walsh PhD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Cross-Sectional Studies
Delivery of Health Care
Female
HIV Infections
Humans
Male
Mental Health Services
Middle Aged
Quality of Life
United States