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Older African Americans and the HIV Care Continuum: A Systematic Review of the Literature, 2003–2018

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Abstract

Evidence suggests that racial disparities in the HIV care continuum persist in older age groups, particularly among African Americans. The objective of this systematic review was to identify factors that facilitate or hinder older African Americans’ engagement in the HIV care continuum. For studies published between 2003 and 2018, we: (1) searched databases using keywords, (2) excluded non-peer-reviewed studies, (3) limited findings to older African Americans and the HIV care continuum, and (4) retrieved and summarized data focused on barriers and facilitators of the HIV care continuum. Among the 1023 studies extracted, 13 were included: diagnosis/testing (n = 1), engagement in care (n = 7), and antiretroviral adherence (n = 5). Barriers included lack of HIV risk awareness, routine testing, and healthcare access, stigma, and multimorbidities. Social support, health/medication literacy, and increased self-efficacy facilitated engagement. A targeted focus on older African Americans is needed to achieve national goals of improving HIV care and treatment outcomes.

Resumen

La evidencia sugiere que disparidades raciales en el cuidado continuo del VIH persisten en los grupos de mayor edad, particularmente entre los afroamericanos. El objetivo de esta revisión sistemática fue identificar los factores que facilitan u obstaculizan la participación de afroamericanos mayores en el cuidado continuo del VIH. Con respecto a los estudios publicados entre el 2003 y el 2018, nosotros: (1) revisamos bases de datos usando palabras claves, (2) excluimos estudios no revisados por pares, (3) limitamos los resultados a afroamericanos mayores y el cuidado continuo del VIH, y (4) recuperamos y resumimos datos concentrados en las barreras y facilitadores al cuidado continuo del VIH. De los 1023 estudios extraídos, se incluyeron 13: diagnóstico/prueba (n = 1), participación en el cuidado (n = 7) y adhesión antirretroviral (n = 5). Algunas de las barreras incluidas fueron la falta de conciencia de riesgo del VIH, las pruebas rutinarias, y el acceso al cuidado médico, el estigma y las multi-morbosidades. El apoyo social, el conocimiento sobre la salud/medicamentos y una mayor auto-eficacia facilitaron la participación. Para lograr los objetivos nacionales de mejorar el cuidado del VIH y los resultados de tratamiento es necesario enfocarse en afroamericanos mayores.

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References

  1. Centers for Disease Control and Prevention. HIV surveillance report, supplemental report: diagnoses of HIV infections among adults aged 50 years and older in the United States and dependent areas 2011–2016. HIV surveillance supplemental report, 2018; Available at: http://www.cdc.gov/hiv/library/reports/surveillance/Accessed 26 Nov 2018.

  2. Linley L, Prejean J, An Q, Chen M, Hall HI. Racial/ethnic disparities in HIV diagnoses among persons aged 50 years and older in 37 US States, 2005–2008. Am J Public Health. 2012;102(8):1527–34.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Brooks JT, Buchacz K, Gebo KA, Mermin J. HIV infection and older Americans: the public health perspective. Am J Public Health. 2012;102(8):1516–26.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Centers for Disease Control and Prevention. Vital signs: HIV prevention through care and treatment-United States: MMWR, 2011; 1618–1623. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6047a4.htm. Accesssed 26 Nov 2018.

  6. Doshi RK, Milberg J, Isenberg D, et al. High rates of retention and viral suppression in the US HIV safety net system: HIV care continuum in the Ryan White HIV/AIDS Program, 2011. Clin Infect Dis. 2014;60(1):117–25.

    Article  PubMed  Google Scholar 

  7. Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57(8):1164–71.

    Article  PubMed  Google Scholar 

  8. Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.

    Article  PubMed  Google Scholar 

  9. Hall HI, Frazier EL, Rhodes P, et al. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med. 2013;173(14):1337–44.

    Article  PubMed  Google Scholar 

  10. HIV.gov. What is the HIV care continuum? Secondary what is the HIV care continuum? 2016. https://www.hiv.gov/federal-response/policies-issues/hiv-aids-care-continuum. Accessed 26 Nov 2018.

  11. Whiteside OY, Cohen SM, Bradley H, Skarbinski J, Hall I, Lansky A. Progress along the continuum of HIV care among blacks with diagnosed HIV-United States, 2010. MMWR. 2014;63(5):85–9.

    PubMed  PubMed Central  Google Scholar 

  12. Ribaudo HJ, Smith KY, Robbins GK, et al. Racial differences in response to antiretroviral therapy for HIV infection: an AIDS clinical trials group (ACTG) study analysis. Clin Infect Dis. 2013;57(11):1607–17.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Earnshaw VA, Bogart LM, Dovidio JF, Williams DR. Stigma and racial/ethnic HIV disparities: moving toward resilience. Am Psychol. 2013;68(4):225.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Brawner BM. A multilevel understanding of HIV/AIDS disease burden among African American women. J Obst Gynecol Neonatal Nurs. 2014;43(5):633–43.

    Article  Google Scholar 

  15. Buot M-LG, Docena JP, Ratemo BK, et al. Beyond race and place: distal sociological determinants of HIV disparities. PLoS ONE. 2014;9(4):e91711.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Davis SK, Tucker-Brown A. The effects of social determinants on Black women’s HIV risk: HIV is bigger than biology. J Black Stud. 2013:0021934713481805.

  17. Sharpe TT, Voûte C, Rose MA, Cleveland J, Dean HD, Fenton K. Social determinants of HIV/AIDS and sexually transmitted diseases among black women: implications for health equity. J Womens Health. 2012;21(3):249–54.

    Article  Google Scholar 

  18. Nwangwu-Ike N, Frazier EL, Crepaz N, Tie Y, Sutton MY. Racial and ethnic differences in viral suppression among HIV-positive women in care. JAIDS. 2018;79(2):e56–68.

    PubMed  Google Scholar 

  19. Geter A, Sutton MY, Hubbard McCree D. Social and structural determinants of HIV treatment and care among black women living with HIV infection: a systematic review: 2005–2016. AIDS Care. 2018;30(4):409–16.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Turan B, Hatcher AM, Weiser SD, Johnson MO, Rice WS, Turan JM. Framing mechanisms linking HIV-related stigma, adherence to treatment, and health outcomes. Am J Public Health. 2017;107(6):863–9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Brewer RA, Chrestman S, Mukherjee S, et al. Exploring the correlates of linkage to HIV medical care among persons living with HIV infection (PLWH) in the deep south: results and lessons learned from the louisiana positive charge initiative. AIDS Behav. 2018;22(8):2615–26.

    Article  PubMed  Google Scholar 

  22. Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2016. HIV Surveillance Report. 2017. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-22-2.pdf. Accessed 26 Nov 2018.

  23. Guo Y, Sims OT. Assessment of recent HIV testing among older adults in the United States. Soc Work Health Care. 2017;56(9):855–64.

    Article  PubMed  Google Scholar 

  24. Davis T, Teaster PB, Watkins JF, Thornton AC, Alexander L, Zanjani F. A qualitative approach to increasing HIV prevention in primary care settings for older adults: perspectives from primary care providers. J Appl Gerontol. 2016;37(7):840–55.

    Article  PubMed  Google Scholar 

  25. Centers for Disease Control and Prevention. HIV among people aged 50 and older, 2018. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Accessed 26 Novs 2018.

  26. High KP, Brennan-Ing M, Clifford DB, et al. HIV and aging: state of knowledge and areas of critical need for research. A report to the NIH Office of AIDS Research by the HIV and Aging Working Group. JAIDS. 1999;60(1):S1–18.

    Google Scholar 

  27. Emlet CA. “You’re awfully old to have this disease”: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist. 2006;46(6):781–90.

    Article  PubMed  Google Scholar 

  28. Emlet CA. An examination of the social networks and social isolation in older and younger adults living with HIV/AIDS. Health Soc Work. 2006;31(4):299–308.

    Article  PubMed  Google Scholar 

  29. Emlet CA. Experiences of stigma in older adults living with HIV/AIDS: a mixed-methods analysis. AIDS Patient Care STDS. 2007;21(10):740–52.

    Article  PubMed  Google Scholar 

  30. Shippy RA, Karpiak SE. The aging HIV/AIDS population: fragile social networks. Aging Ment Health. 2005;9(3):246–54.

    Article  CAS  PubMed  Google Scholar 

  31. Foster PP, Gaskins SW. Older African Americans’ management of HIV/AIDS stigma. AIDS Care. 2009;21(10):1306–12.

    Article  PubMed  Google Scholar 

  32. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  PubMed  Google Scholar 

  33. Akers A, Bernstein L, Henderson S, Doyle J, Corbie-Smith G. Factors associated with lack of interest in HIV testing in older at-risk women. J Womens Health. 2007;16(6):842–58.

    Article  Google Scholar 

  34. Sangaramoorthy T, Jamison A, Dyer T. Intersectional stigma among midlife and older Black women living with HIV. Cult Health Sex. 2017;19(12):1329–43.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Warren-Jeanpiere L, Dillaway H, Hamilton P, Young M, Goparaju L. Life begins at 60: identifying the social support needs of African American women aging with HIV. J Health Care Poor Underserved. 2017;28(1):389–405.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Blake BJ, Taylor GAJ, Sowell RL. Exploring experiences and perceptions of older African American males aging with HIV in the rural southern United States. Am J Mens Health. 2017;11(2):221–32.

    Article  PubMed  Google Scholar 

  37. DeGrezia MG, Scrandis D. Successful coping in urban, community-dwelling older adults with HIV. J Assoc Nurses AIDS Care. 2015;26(2):151–63.

    Article  PubMed  Google Scholar 

  38. McDoom MM, Bokhour B, Sullivan M, Drainoni M-L. How older black women perceive the effects of stigma and social support on engagement in HIV care. AIDS Patient Care STDS. 2015;29(2):95–101.

    Article  PubMed  Google Scholar 

  39. Sheth AN, Moore RD, Gebo KA. Provision of general and HIV-specific health maintenance in middle aged and older patients in an urban HIV clinic. AIDS Patient Care STDS. 2006;20(5):318–25.

    Article  PubMed  Google Scholar 

  40. Warren-Jeanpiere L, Dillaway H, Hamilton P, Young M, Goparaju L. Taking it one day at a time: African American women aging with HIV and Co-morbidities. AIDS Patient Care STDS. 2014;28(7):372–80.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Abara WE, Smith L, Zhang S, Fairchild AJ, Heiman HJ, Rust G. The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS. Am J Public Health. 2014;104(11):e135–41.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Abara WE, Adekeye OA, Xu J, Heiman HJ, Rust G. Correlates of combination antiretroviral adherence among recently diagnosed older HIV-infected adults between 50 and 64 years. AIDS Behav. 2016;20(11):2674–81.

    Article  PubMed  PubMed Central  Google Scholar 

  43. McCoy K, Waldrop-Valverde D, Balderson BH, Mahoney C, Catz S. Correlates of antiretroviral therapy adherence among HIV-infected older adults. J Int Assoc Provid AIDS Care. 2016;15(3):248–55.

    Article  PubMed  Google Scholar 

  44. Monroe AK, Rowe TL, Moore RD, Chander G. Medication adherence in HIV-positive patients with diabetes or hypertension: a focus group study. BMC Health Serv Res. 2013;13(1):488.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Sangaramoorthy T, Jamison AM, Dyer TV. HIV stigma, retention in care, and adherence Among older black women living with HIV. J Assoc Nurses AIDS Care. 2017;28(4):518–31.

    Article  PubMed  Google Scholar 

  46. United States Preventive Task Force. Human Immunodeficiency Virus (HIV) Infection: Screening, 2013. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/human-immunodeficiency-virus-hiv-infection-screening. Accessed 26 Nov 2018.

  47. Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR. 2006;55(RR14):1–17.

    PubMed  Google Scholar 

  48. Blank AE, Fletcher J, Verdecias N, Garcia I, Blackstock O, Cunningham C. Factors associated with retention and viral suppression among a cohort of HIV+ women of color. AIDS Patient Care STDs. 2015;29(Suppl 1):S27–35.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Quinn K, Sanders C, Petroll AE. “HIV is not going to kill me, old age is!”: the intersection of aging and HIV for older HIV-infected adults in rural communities. AIDS Educ Prev. 2017;29(1):62–76.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Adekeye OA, Heiman HJ, Onyeabor OS, Hyacinth HI. The new invincibles: HIV screening among older adults in the US. PLoS ONE. 2012;7(8):e43618.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Ford CL, Lee S-J, Wallace SP, Nakazono T, Newman PA, Cunningham WE. HIV testing among clients in high HIV prevalence venues: disparities between older and younger adults. AIDS Care. 2015;27(2):189–97.

    Article  PubMed  Google Scholar 

  52. Beaulaurier R, Fortuna K, Lind D, Emlet CA. Attitudes and stereotypes regarding older women and HIV risk. J Women Aging. 2014;26(4):351–68.

    Article  PubMed  Google Scholar 

  53. Durvasula R. HIV/AIDS in older women: unique challenges, unmet needs. Behav Med. 2014;40(3):85–98.

    Article  PubMed  Google Scholar 

  54. Savasta AM. HIV: associated transmission risks in older adults: an integrative review of the literature. J Assoc Nurses AIDS Care. 2004;15(1):50–9.

    Article  PubMed  Google Scholar 

  55. Milaszewski D, Greto E, Klochkov T, Fuller-Thomson E. A systematic review of education for the prevention of HIV/AIDS among older adults. J Evid Based Soc Work. 2012;9(3):213–30.

    Article  PubMed  Google Scholar 

  56. Bokhour BG, Saifu H, Goetz MB, et al. The role of evidence and context for implementing a multimodal intervention to increase HIV testing. Implement Sci. 2015;10(1):22.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Hosek SG, Lemos D, Harper GW, Telander K. Evaulating the acceptability and feasibility of project ACCEPT: an intervention for youth newly diagnosed with HIV. AIDS Educ Prev. 2011;23(2):128–44. https://doi.org/10.1521/aeap.2011.23.2.128.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Rao D, Desmond M, Andrasik M, et al. Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. AIDS Patient Care STDs. 2012;26(10):614–20.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16(3S2):18734.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372(9640):764–75.

    Article  PubMed  Google Scholar 

  61. Waldrop-Valverde D, Osborn CY, Rodriguez A, Rothman RL, Kumar M, Jones DL. Numeracy skills explain racial differences in HIV medication management. AIDS Behav. 2010;14(4):799–806.

    Article  PubMed  Google Scholar 

  62. Gakumo CA, Enah CC, Vance DE, Sahinoglu E, Raper JL. “Keep it simple”: older African Americans’ preferences for a health literacy intervention in HIV management. Patient Prefer Adherence. 2015;9:217–23.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Swendeman D, Ingram BL, Rotheram-Borus MJ. Common elements in self-management of HIV and other chronic illnesses: an integrative framework. AIDS Care. 2009;21(10):1321–34.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors wish to thank Emilia Guevara for her help in translating the abstract into Spanish.

Funding

The work was supported by a seed grant from the University of Maryland ADVANCE Program [PI: Sangaramoorthy and Dyer] and the US National Institutes of Health’s National Institute of Drug Abuse [Grant Number R03 DA03713101; PI: Dyer]. The findings and conclusions of this manuscript do not represent the official views or policies of the University of Maryland or the US National Institutes of Health.

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Authors and Affiliations

  1. Department of Anthropology, University of Maryland, 1111 Woods Hall, 4302 Chapel Lane, College Park, MD, 20742, USA

    Thurka Sangaramoorthy

  2. Center for Health Equity, University of Maryland, College Park, MD, USA

    Amelia Jamison

  3. Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA

    Typhanye Dyer

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  1. Thurka Sangaramoorthy
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Correspondence to Thurka Sangaramoorthy.

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Sangaramoorthy, T., Jamison, A. & Dyer, T. Older African Americans and the HIV Care Continuum: A Systematic Review of the Literature, 2003–2018. AIDS Behav 23, 973–983 (2019). https://doi.org/10.1007/s10461-018-2354-4

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