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Health Literacy and Demographic Disparities in HIV Care Continuum Outcomes

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Abstract

Studies evaluating the association between human immunodeficiency virus (HIV) infection continuum of care outcomes [antiretroviral (ART) adherence, retention in care, viral suppression] and health literacy have yielded conflicting results. Moreover, studies from the southern United States, a region of the country disproportionately affected by the HIV epidemic and low health literacy, are lacking. We conducted an observational cohort study among 575 people living with HIV (PLWH) at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee). Health literacy was measured using the brief health literacy screen, a short tool which can be administered verbally by trained clinical personnel. Low health literacy was associated with a lack of viral suppression, but not with poor ART adherence or poor retention. Age and racial disparities in continuum of care outcomes persisted after accounting for health literacy, suggesting that factors in addition to health literacy must be addressed in order to improve outcomes for PLWH.

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Funding

This work was supported in part by the National Institutes of Health: K01 AI131895 (Rebeiro), K08 AI104352 (Pettit), and P30 AI110527 (Tennessee Center for AIDS Research).

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Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, 1161 21st Avenue S., A-2200 MCN, Nashville, TN, 37232, USA

    Peter F. Rebeiro, Megan Turner, Sally S. Bebawy, Anna K. Person, Timothy R. Sterling & April C. Pettit

  2. Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA

    Tristan D. McPherson

  3. Institute for Medicine and Public Health, Center for Effective Health Communication, Vanderbilt University School of Medicine, Nashville, TN, USA

    Kathryn M. Goggins & Sunil Kripalani

  4. Indiana University School of Medicine, Bloomington, IN, USA

    William B. Rogers

  5. Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Lauren Brinkley-Rubinstein

  6. Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA

    Sunil Kripalani

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  1. Peter F. Rebeiro
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  2. Tristan D. McPherson
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  3. Kathryn M. Goggins
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  4. Megan Turner
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  7. Lauren Brinkley-Rubinstein
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  8. Anna K. Person
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  9. Timothy R. Sterling
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  10. Sunil Kripalani
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  11. April C. Pettit
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Correspondence to Peter F. Rebeiro.

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All procedures performed in studies involving human participants were in accordance with the Ethical Standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was waived in accordance with standards for “on the shelf data,” and the waiver was approved by the Vanderbilt University School of Medicine Institutional Review Board (IRB).

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Rebeiro, P.F., McPherson, T.D., Goggins, K.M. et al. Health Literacy and Demographic Disparities in HIV Care Continuum Outcomes. AIDS Behav 22, 2604–2614 (2018). https://doi.org/10.1007/s10461-018-2092-7

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