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Assessing the Relationship Between HIV Quality of Care and Treatment Literacy on ART Adherence and Viral Suppression Among Female Sex Workers Living in the Dominican Republic

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Abstract

This study assessed the relationship between the quality of HIV care and treatment literacy on antiretroviral therapy (ART) adherence and viral suppression among female sex workers (FSWs) living with HIV (n = 211) in Santo Domingo, Dominican Republic. Multivariable logistic regression results indicate better patient-provider communication (AOR 1.04; 95% CI 1.01–1.07) and respectful treatment (AOR 2.17; 95% CI 1.09–4.32) increase the odds of viral suppression, while higher costs reduce both the odds of ART adherence (AOR 0.57, 95% CI 0.34- 0.95) and being virally suppressed (AOR 0.59, 95% CI 0.41–0.85). Greater treatment literacy was associated with an increased odds of ART adherence (AOR 4.15 for understanding of viral load; 95% CI 1.50–11.52) and viral suppression (AOR 2.75 for understanding of CD4 count; 95% CI 1.31–5.80). Findings support investments in treatment education, effective and respectful patient-provider communication, dignified care, and cost-support for associated HIV care costs to facilitate FSWs’ pathway towards viral suppression.

Resumen

Este estudio evaluó la relación entre la calidad de la atención para el VIH y la alfabetización relacionada al tratamiento sobre la adherencia a la terapia antirretroviral (TAR) y la supresión viral entre las trabajadoras sexuales (TRSX) que viven con el VIH (n = 211) en Santo Domingo, República Dominicana. Los resultados de la regresión logística multivariable indican una mejor comunicación entre el paciente y el proveedor (RMa: 1.04; IC del 95%: 1.01–1.07) y un tratamiento respetuoso (RMa: 2.17; IC del 95%: 1.09–4.32) aumenta la probabilidad de supresión viral, mientras que los costos elevados reducen tanto las probabilidades de adherencia al TAR (RMa: 0.57; IC del 95%: 0.34–0.95) como la supresión viral (RMa: 0.59, IC del 95%: 0.41–0.85). Una mayor alfabetización relacionada al tratamiento se asoció con una mayor probabilidad de adherencia al TAR (RMa: 4.15 para la comprensión de la carga viral; IC del 95%: 1.50–11.52) y la supresión viral (RMa: 2.75 para la comprensión del conteo de CD4; IC del 95%: 1.31–5.80). Los hallazgos respaldan inversiones en educación sobre el tratamiento, la comunicación efectiva y respetuosa entre el paciente y el proveedor, la atención digna y el apoyo económico para los costos asociados con la atención del VIH para facilitar el camino de las TRSX hacia la supresión viral.

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Data Availability

Due to the sensitivity around the data, the data will not be deposited in a data repository. However, data is available at the request of the first author.

Code availability

Statistical analysis code is available at the request of the first author.

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Acknowledgements

The authors would like to thank all participants and the study team for their contributions and efforts in making this study possible. In addition, we thank Drs. Katherine Clegg Smith and Kathleen Raquel Page for their invaluable input on and review of the work.

Funding

This study was supported by the National Institute of Mental Health through R01MH110158 (Principal Investigator: Deanna Kerrigan).

Author information

Authors and Affiliations

  1. Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, USA

    Tahilin Sanchez Karver & Deanna Kerrigan

  2. HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic

    Yeycy Donastorg, Martha Perez & Hoisex Gomez

  3. Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Noya Galai & David Celentano

  4. Department of Statistics, University of Haifa, Haifa, Israel

    Noya Galai

  5. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA

    Clare Barrington

  6. Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    Tahilin Sanchez Karver

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  1. Tahilin Sanchez Karver
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Contributions

TSK, DK, DC, and CB helped conceptualize the research question for the current study. DK, CB, YD, MP, HG, and TSK supported the implementation of the study. YD, MP and HG supported the data acquisition for the study. DK, DC and NG provided feedback to the data analyses. TSK led the manuscript development. All authors contributed to the review of the paper. All authors have reviewed the final version of the manuscript.

Corresponding author

Correspondence to Tahilin Sanchez Karver.

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Conflict of interest

There are no conflict of interests to declare.

Ethical Approval

This study was approved by the Institutional Review Boards of Johns Hopkins University Bloomberg School of Public Health (Baltimore, MD), and from IDCP Unidad de Vacunas e Investigación and the Consejo Nacional de Bioética en Salud (Santo Domingo, DR).

Consent to Participate

All participants provided oral informed consent to participate in the current study. Prior to issuing informed consent, this declaration was read: “I have read the consent form completely before the participant and she voluntarily agreed to participate in the study.”

Consent for Publication

All participants provided oral informed consent for their information to be used as an aggregate and de-identified for the purposes to publish or disseminate information on the results to describe the research study. Extract from consent form indicates: “Results of this research will be used for the purposes described in this study. This information may be published, but you will not be identified. Information we obtain from you concerning this research will remain confidential.”

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Karver, T.S., Donastorg, Y., Perez, M. et al. Assessing the Relationship Between HIV Quality of Care and Treatment Literacy on ART Adherence and Viral Suppression Among Female Sex Workers Living in the Dominican Republic. AIDS Behav 26, 3056–3067 (2022). https://doi.org/10.1007/s10461-022-03647-z

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