AIDS and Behavior

, Volume 17, Issue 1, pp 242–249 | Cite as

Personal HIV Knowledge, Appointment Adherence and HIV Outcomes

  • Deborah Jones
  • Ryan Cook
  • Allan Rodriguez
  • Drenna Waldrop-Valverde
Original Paper


HIV knowledge may impact patient access, understanding, and utilization of HIV medical information. This study explored the relationship between personal HIV knowledge, appointment adherence and treatment outcomes. HIV-infected individuals (n = 210) were assessed on factors related to HIV knowledge and appointment adherence. Adherence data and laboratory values were extracted from medical records. HIV knowledge was measured by participants’ knowledge of their CD4 count and viral load (VL) and adherence was defined as attendance at >75 % of appointments. Two-thirds of participants were adherent, but only one-third knew their CD4 count and VL. Controlling for time since last appointment, HIV knowledge more than doubled the odds of appointment adherence. In combination with relationship with provider, knowledge predicted increased CD4 count and increased odds of an undetectable VL by almost five times. Personal HIV knowledge may be a valuable indicator of engagement in care and may also facilitate improved treatment outcomes.


HIV Adherence Knowledge Treatment outcomes 


El conocimiento acerca del VIH impacta el acceso, comprensión y utilización de la información médica de los pacientes. Este estudio exploró la relación entre el conocimiento personal sobre VIH, la adherencia a las visitas médicas y los resultados del tratamiento. Los individuos VIH positivos (n = 210) fueron analizados sobre factores relacionados al conocimiento sobre VIH y la adherencia a las visitas médicas. Los datos de laboratorio fueron extraídos de las historias médicas. Los datos sobre adherencia sobre VIH fueron medidos a través del conocimiento de los pacientes sobre su CD4 y su carga viral (CV) y la adherencia se definió como la asistencia a más del 75 % de las visitas. Dos tercios de los participantes fueron adherentes, pero solo un tercio de ellos conocía su CD4 y su CV. Controlando el tiempo desde la última consulta médica, el conocimiento sobre VIH fue más del doble que la adherencia a las visitas médicas. Combinado con la relación con el proveedor, la predicción sobre el conocimiento aumentó el contaje de CD4 y la proporción de una CV no detectable fue casi 5 veces mayor. El conocimiento sobre el VIH puede ser un valioso indicador de compromiso con la salud que facilita y mejora los resultados del tratamien.



This study was made possible by a grant from NIH, R21 MH 084814.


  1. 1.
    Mugavero MJ, Amico KR, Westfall AO, et al. Early retention in HIV care and viral load suppression: implications for a test and treat approach to HIV prevention. J Acquir Immune Defic Syndr. 2012;59:86–93.PubMedCrossRefGoogle Scholar
  2. 2.
    Brennan AT, Maskew M, Sanne I, Fox MP. The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa. J Int AIDS Soc. 2010;13:49.PubMedCrossRefGoogle Scholar
  3. 3.
    Park WB, Choe PG, Kim SH, et al. One-year adherence to clinic visits after highly active antiretroviral therapy: a predictor of clinical progress in HIV patients. J Intern Med. 2006;261:268–75.CrossRefGoogle Scholar
  4. 4.
    Robbins GK, Daniels B, Zheng H, Chueh H, Meigs JB, Freedberg KA. Predictors of antiretroviral treatment failure in an urban HIV clinic. J Acquir Immune Defic Syndr. 2007;44:30–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Berg MB, Safren SA, Mimiaga MJ, Grasso C, Boswell S, Mayer KH. Nonadherence to medical appointments is associated with increased plasma HIV RNA and decreased CD4 cell counts in a community-based HIV primary care clinic. AIDS Care. 2005;17:902–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Cohen MS, Chen YQ, McCauley M, et al. HPTN 052 Study Team. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.PubMedCrossRefGoogle Scholar
  7. 7.
    Wolf MS, Davis TC, Arozullah A, et al. Relation between literacy and HIV treatment knowledge among patients on HAART regimens. AIDS Care. 2005;17:863–73.PubMedCrossRefGoogle Scholar
  8. 8.
    Wolf MS, Davis TC, Osborn CY, Skripkauskas S, Bennett CL, Makoul G. Literacy, self-efficacy, and HIV medication adherence. Patient Educ Couns. 2007;65:253–60.PubMedCrossRefGoogle Scholar
  9. 9.
    Nutbeam D. Evaluating health promotion—progress, problems and solutions. Health Promot Int. 1998;13:27–44.CrossRefGoogle Scholar
  10. 10.
    Wolf MS, Gazmararian JA, Baker DW. Health literacy and functional health status among older adults. Arch Intern Med. 2005;165:1946–52.PubMedCrossRefGoogle Scholar
  11. 11.
    Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97–107.PubMedGoogle Scholar
  12. 12.
    Kalichman SC, Pope H, White D, et al. Association between health literacy and HIV treatment adherence: further evidence from objectively measured medication adherence. J Int Assoc Physicians AIDS Care. 2008;7:317–23.CrossRefGoogle Scholar
  13. 13.
    Peterson NB, Dwyer KA, Mulvaney SA, Dietrich MS, Rothman RL. The influence of health literacy on colorectal cancer screening knowledge, beliefs and behavior. J Natl Med Assoc. 2007;99:1105–12.PubMedGoogle Scholar
  14. 14.
    Catz SL, McClure JB, Jones GN, Brantley PJ. Predictors of outpatient medical appointment attendance among persons with HIV. AIDS Care. 1999;11:361–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Blair JM, McNaghten AD, Frazier EL, Skarbinski J, Huang P, Heffelfinger JD. Clinical and behavioral characteristics of adults receiving medical care for HIV infection—MedicalMonitoring Project, United States, 2007. MMWR Surveill Summ. 2011;60:1–20.PubMedGoogle Scholar
  16. 16.
    McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the addiction severity index. J Subst Abuse Treat. 1992;9:199–213.PubMedCrossRefGoogle Scholar
  17. 17.
    Bodenlos JS, Grothe KB, Whitehead D, Konkle-Parker DJ, Jones GN, Brantley PJ. Attitudes toward health care providers and appointment attendance in HIV/AIDS patients. J Assoc Nurses AIDS Care. 2007;18:65–73.PubMedCrossRefGoogle Scholar
  18. 18.
    Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10:77–84.PubMedGoogle Scholar
  19. 19.
    Radloff L. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  20. 20.
    Power C, Selnes OA, Grim JA, McArthur JC. HIV dementia scale: a rapid screening test. J Acquir Immune Defic Syndr Hum Retrovirol. 1995;8:273–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Bakken S, Holzemer WL, Brown MA, et al. Relationships between perception of engagement with health care provider and demographic characteristics, health status, and adherence to therapeutic regimen in persons with HIV/AIDS. AIDS Patient Care STDS. 2000;14:189–97.PubMedCrossRefGoogle Scholar
  22. 22.
    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111:455–74.PubMedCrossRefGoogle Scholar
  23. 23.
    Fisher JD, Fisher WA, Amico KR, Harman JJ. An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychol. 2006;25:462–73.PubMedCrossRefGoogle Scholar
  24. 24.
    Mallinson RK, Relf MV, Dekker D, Dolan K, Darcy A, Ford A. Maintaining normalcy: a grounded theory of engaging in HIV-oriented primary medical care. ANS Adv Nurs Sci. 2005;28:26–277.Google Scholar
  25. 25.
    Waldrop-Valverde D, Jones D, Weiss S, Kumar M, Metsch L. The effects of low literacy and cognitive impairment on medication adherence in HIV positive injecting drug users. AIDS Care. 2008;20:1202–10.PubMedCrossRefGoogle Scholar
  26. 26.
    Waldrop-Valverde D, Osborn CY, Rodriquez A, Rothman RL, Kumar M, Jones DL. Numeracy skills explain racial differences in HIV medication management. AIDS Behav. 2010;14:799–806.PubMedCrossRefGoogle Scholar
  27. 27.
    Relf MV, Mallinson RK, Pawlowski L, Dolan K, Dekker D. HIV-related stigma among persons attending an urban HIV clinic. J Multicult Nurs Health. 2005;11:14–22.Google Scholar
  28. 28.
    Israelski D, Gore-Felton C, Power R, Wood MJ, Koopman C. Sociodemographic characteristics associated with medical appointment adherence among HIV seropositive patients seeking treatment in a county outpatient facility. Prev Med. 2001;33:470–5.PubMedCrossRefGoogle Scholar
  29. 29.
    Mugavero MJ, Lin H, Allison JJ, et al. Failure to establish HIV care: characterizing the “no show” phenomenon. Clin Infect Dis. 2007;45:127–30.PubMedCrossRefGoogle Scholar
  30. 30.
    Giordano TP, Visnegarwala F, White AC, et al. Patients referred to an urban HIV clinic frequently fail to establish care: factors predicting failure. AIDS Care. 2005;17:773–83.PubMedCrossRefGoogle Scholar
  31. 31.
    Wagner GJ, Goggin K, Remien RH, et al. A closer look at depression and its relationship to HIV antiretroviral adherence. Ann Behav Med. 2011;42:352–60.PubMedCrossRefGoogle Scholar
  32. 32.
    Sherr L, Clucas C, Harding R, Sibley E, Catalan J. HIV and Depression—a systematic review of interventions. Psychol Health Med. 2011;16:493–527.PubMedCrossRefGoogle Scholar
  33. 33.
    Williams MV, Davis T, Parker RM, Weiss BD. The role of health literacy in patient physician communication. Fam Med. 2002;34:383–9.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Deborah Jones
    • 1
  • Ryan Cook
    • 1
  • Allan Rodriguez
    • 2
  • Drenna Waldrop-Valverde
    • 3
  1. 1.Department of Psychiatry and Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiUSA
  2. 2.Department of Infectious DiseasesUniversity of Miami Miller School of MedicineMiamiUSA
  3. 3.Nell Hodgson Woodruff School of NursingEmory UniversityAtlantaUSA

Personalised recommendations