African Americans (AA) account for 40% of the nearly 1.2 million persons living with HIV/AIDS in the United States. Of the nearly 40,000 new annual HIV diagnoses, 45% occur among AAs. AAs also have the highest rates of AIDS diagnoses and are more likely to die from HIV/AIDS than any other racial/ethnic group. A major contributor to the morbidity and mortality of HIV/AIDS among AAs is poor retention in HIV/AIDS care. Of AAs who are diagnosed and linked to care, only 34% attend regularly scheduled HIV/AIDS medical appointments, the lowest retention in care among racial/ethnic groups. Poor retention in care is associated with higher HIV viral load, increased risk for viral transmission, and increased mortality. AAs also are at increased risk of low health literacy, which preliminary evidence suggests may contribute to reduced retention in care. Health literacy?the ability to access, process, and use health information to make informed health decisions? is associated with a variety of poor health outcomes, including poor utilization of available health services, low medication adherence, and increased mortality. Limited evidence is available regarding the effect of health literacy on retention in care. Previous research found that the odds of individuals attending more than 75% of their regularly scheduled HIV/AIDS visits doubled among those who knew the correct value of their HIV viral load or CD4 count. Personal HIV knowledge has also been associated with undetectable HIV viral load and increased CD4 count, but these findings are inconsistent across studies. Among non-HIV/AIDS populations, evidence suggests that health literacy may mediate the relationship between race and health outcomes, but this causal pathway has yet to been examined for retention in HIV/AIDS care. Due to the emerging evidence on the effects of health literacy in retention in care, as well as causal pathways linking health literacy and health outcomes among disparate populations, examination of these pathways on retention in care among AAs living with HIV/AIDS is a necessary next step. The purpose of this F31 fellowship, entitled ENRICH (Examining Retention in Care and Health Literacy), is to utilize an adapted health literacy model to evaluate the effect of health literacy on retention in care and its subsequent effect on racial disparities and HIV clinical outcomes. ENRICH is an ancillary study to a nearly completed R01 study (Project READ?R01 MH092284: PI, D. Waldrop-Valverde) that assessed the association of health literacy on medication discordance. ENRICH will include an additional prospective measure of retention in HIV/AIDS care and HIV clinical outcomes (HIV viral load), captured via medical chart review, among Project READ?s 700 study participants. ENRICH operationalizes retention in care as visit adherence, defined as the proportion of scheduled HIV/AIDS visits kept over a 24-month follow-up period. Reducing health disparities among HIV/AIDS patients is a priority of the Office of AIDS Research and this study will improve understanding of potentially modifiable contributors to health disparities.
Low health literacy and poor retention in HIV/AIDS care may contribute significantly to the morbidity and mortality of HIV/AIDS among African Americans. The proposed study aims to understand the role of health literacy and retention in care on HIV/AIDS health disparities. Knowledge gained from this study will provide insight into mechanisms underlying health disparities among African Americans living with HIV/AIDS and may inform the development of interventions to improve health literacy and retention in care, in order to reduce health inequities.
