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Factors Related to Biological Sex Differences in Engagement with Healthcare Providers in Persons Living with HIV

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Abstract

Little is known about how engagement with healthcare providers mediates the relationship between psychosocial factors (anxiety, depression, stigma) and medication adherence among persons living with HIV (PLWH). Moreover, little research has investigated potential biological sex differences in this relationship. We conducted a secondary analysis of data collected from four projects (N = 281) focused on improving health outcomes in PLWH. Males displayed (a) negative association between depression and engagement with healthcare providers (β = − 0.02, z = − 3.20, p = 0.001) and (b) positive association between engagement with healthcare providers and medication adherence (β = 0.55, OR = 1.73, z = 2.62, p = 0.009). Females showed no association between any of these factors. Anxiety and stigma were not significantly associated with medication adherence. Path analysis modeling for males had a very good fit (CFI = 1, TLI = 1, RMSEA = 0); none of the regression coefficients was significant for females. The significant relationship between depression and medication adherence among males was fully mediated by engagement with healthcare providers. Findings suggest that adherence interventions for PLWH should be tailored by biological sex.

Résumé

Poco se sabe cómo la interacción con proveedores médicos funciona en la relación entre factores psicosociales (ansiedad, depresión, estigma) y adherencia a medicamentos en personas viviendo con VIH (PVV). Además, pocos estudios han investigado posibles diferencias en el sexo biológico en estas relacione. Dirigimos un análisis secundario de cuatro proyectos (N = 281) enfocados en PVV. Hombres demostraron (a) una asociación negativa entre depresión e interacción con proveedores médicos (β = -0.02, z = -3.20, p = 0.001) y (b) una asociación positive entre interacción con proveedores médicos y adherencia a medicamentos (β = 0.55, OR = 1.73, z = 2.62, p = 0.009). Mujeres no demostraron asociación entre estos factores. Ansiedad y estigma no fueron asociados significativamente con la adherencia a medicamentos. El modelo de análisis del camino para hombres tuvo un muy ajuste (CFI = 1, TLI = 1, RMSEA = 0); ninguna de los coeficientes de regresión fue significativa para mujeres. La relación significativa entre depresión y adherencia a medicamentos para hombres fue completamente mediada por la interacción con proveedores médicos. Las recomendaciones sugieren que las intervenciones de adherencia para PVV deberían ser ajustado por sexo biológico.

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Acknowledgements

This study was funded by the Agency for Healthcare Research and Quality (R01HS025071), the National Institute of Nursing Research of the National Institute of Health (R01NR015737, R01NR015737-02S1, and K24NR018621). DB was funded by the Reducing Health Disparities through Informatics (RHeaDI) training grant funded by the National Institute of Nursing Research (T32 NR007969). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Agency for Healthcare Research and Quality.

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Authors and Affiliations

  1. College of Nursing, University of Colorado Anschutz Medical Campus, 13120 E 19th Ave, C288, Aurora, CO, 80045, USA

    Dawon Baik

  2. School of Nursing, Columbia University, New York, NY, 10032, USA

    Jianfang Liu & Rebecca Schnall

  3. College of Nursing, University of Florida, Gainesville, FL, 32610, USA

    Hwayoung Cho

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  1. Dawon Baik
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  2. Jianfang Liu
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  4. Rebecca Schnall
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Contributions

All authors contributed to the study conception and design. Material preparation, data organization, and data analysis were performed by DB, RS, and JL. The first draft of the manuscript was written by DB and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Dawon Baik.

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Baik, D., Liu, J., Cho, H. et al. Factors Related to Biological Sex Differences in Engagement with Healthcare Providers in Persons Living with HIV. AIDS Behav 24, 2656–2665 (2020). https://doi.org/10.1007/s10461-020-02823-3

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