Correction: Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study

Gwadz, Marya; Cluesman, Sabrina; Freeman, Robert; Dorsen, Caroline; Hawkins, Robert L.; Cleland, Charles M.; Wilton, Leo; Ritchie, Amanda S.; Torbjornsen, Karen; Leonard, Noelle R.; Martinez, Belkis Y.; Silverman, Elizabeth; Israel, Khadija; Kutnick, Alexandra

doi:10.1186/s12939-022-01708-2

Cited by 3 publications

(4 citation statements)

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“…The present study was grounded in an integrated conceptual model developed by our team that combines critical race theory, harm reduction, and self-determination theory, as described in more detail elsewhere [ 24 , 25 ]. This integrated conceptual model aligns with the theory of triadic influence, a social-cognitive theory that highlights the relevance of simultaneous systemic/structural-, social-, and individual/attitudinal-level streams of influence on behavior [ 26 ], as well as highlighting the importance of structural and cultural competency in health care settings.…”

Section: Methodsmentioning

confidence: 99%

“…We began with an initial list of “start codes” along with their operational definitions that was generated by the primary qualitative analysts. This initial start code list was informed by the theories and perspectives framing the study; namely, the integrated conceptual model [ 24 , 25 ] and theory of triadic influence [ 26 ]. Codes were generated that reflected potential systemic barriers (e.g., housing circumstances, poverty), culture and race/ethnicity (e.g., experiences of discrimination and racism, medical distrust), substance use management, autonomy, competence, relatedness, and other factors known to promote or impede engagement along the HIV care continuum (e.g., mental health distress).…”

Section: Methodsmentioning

confidence: 99%

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Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV

Filippone,

Serrano,

Campos

et al. 2023

Int J Equity Health

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Background Racial/ethnic inequities along the HIV care continuum persist in the United States despite substantial federal investment. Numerous studies highlight individual and social-level impediments in HIV, but fewer foreground systemic barriers. The present qualitative study sought to uncover and describe systemic barriers to the HIV care continuum from the perspectives of African American/Black and Latino persons living with HIV (PLWH) with unsuppressed HIV viral load, including how barriers operated and their effects. Methods Participants were African American/Black and Latino PLWH with unsuppressed HIV viral load (N = 41). They were purposively sampled for maximum variability on key indices from a larger study. They engaged in semi-structured in-depth interviews that were audio-recorded and professionally transcribed. Data were analyzed using directed content analysis. Results Participants were 49 years old, on average (SD = 9), 76% were assigned male sex at birth, 83% were African American/Black and 17% Latino, 34% were sexual minorities (i.e., non-heterosexual), and 22% were transgender/gender-nonbinary. All had indications of chronic poverty. Participants had been diagnosed with HIV 19 years prior to the study, on average (SD = 9). The majority (76%) had taken HIV medication in the six weeks before enrollment, but at levels insufficient to reach HIV viral suppression. Findings underscored a primary theme describing chronic poverty as a fundamental cause of poor engagement. Related subthemes were: negative aspects of congregate versus private housing settings (e.g., triggering substance use and social isolation); generally positive experiences with health care providers, although structural and cultural competency appeared insufficient and managing health care systems was difficult; pharmacies illegally purchased HIV medication from PLWH; and COVID-19 exacerbated barriers. Participants described mitigation strategies and evidenced resilience. Conclusions To reduce racial/ethnic inequities and end the HIV epidemic, it is necessary to understand African American/Black and Latino PLWH’s perspectives on the systemic impediments they experience throughout the HIV care continuum. This study uncovers and describes a number of salient barriers and how they operate, including unexpected findings regarding drug diversion and negative aspects of congregate housing. There is growing awareness that systemic racism is a core determinant of systemic barriers to HIV care continuum engagement. Findings are interpreted in this context.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV

Filippone,

Serrano,

Campos

et al. 2023

Int J Equity Health

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“…This session comprised an introduction to the study and its ethos grounded in the conceptual model described above (e.g., emphasizing support for personal decisions about HIV management and any positive change, no pressure, no judgment, and structural and cultural salience) ( 27 , 31 ), a brief needs assessment, and referrals to needed services (e.g., HIV care, food pantries, housing, or clothing) to help overcome structural barriers to HIV care or medication. Participants were informed about the type of financial reward they were eligible to receive and the structure and duration of other components they were randomly assigned to receive during the core session.…”

Section: Methodsmentioning

confidence: 99%

“…The S-CAP intervention was grounded in a conceptual model that integrates critical race theory, harm reduction, and self-determination theory, as described in more detail elsewhere ( 27 , 31 ). As such, the S-CAP intervention prioritized support of participants' own health decisions and their autonomy overall, reinforced any steps toward positive change, and attended to and sought to resolve structural barriers to HIV management.…”

Section: Introductionmentioning

confidence: 99%

A virtual pilot optimization trial for African American/Black and Latino persons with non-suppressed HIV viral load grounded in motivational interviewing and behavioral economics

Filippone

Serrano

Gwadz

et al. 2023

Front. Public Health

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IntroductionVirtual and low-touch behavioral interventions are needed for African American/Black and Latino persons living with HIV (PLWH) with barriers to HIV viral suppression, particularly during COVID-19. Guided by the multiphase optimization strategy, we explored three components for PLWH without viral suppression, grounded in motivational interviewing and behavioral economics: (1) motivational interviewing counseling, (2) 21-weeks of automated text messages and quiz questions about HIV management, and (3) financial rewards for viral suppression (lottery prize vs. fixed compensation).MethodsThis pilot optimization trial used sequential explanatory mixed methods to explore the components' feasibility, acceptability, and preliminary evidence of effects using an efficient factorial design. The primary outcome was viral suppression. Participants engaged in baseline and two structured follow-up assessments over an 8-month period, and provided laboratory reports to document HIV viral load. A subset engaged in qualitative interviews. We carried out descriptive quantitative analyses. Then, qualitative data were analyzed using directed content analysis. Data integration used the joint display method.ResultsParticipants (N = 80) were 49 years old, on average (SD = 9), and 75% were assigned male sex at birth. Most (79%) were African American/Black, and the remainder were Latino. Participants were diagnosed with HIV 20 years previously on average (SD = 9). Overall, components were feasible (>80% attended) and acceptability was satisfactory. A total of 39% (26/66) who provided laboratory reports at follow-up evidenced viral suppression. Findings suggested no components were entirely unsuccessful. The lottery prize compared to fixed compensation was the most promising component level. In qualitative analyses, all components were seen as beneficial to individual wellbeing. The lottery prize appeared more interesting and engaging than fixed compensation. However, structural barriers including financial hardship interfered with abilities to reach viral suppression. The integrated analyses yielded areas of convergence and discrepancy and qualitative findings added depth and context to the quantitative results.ConclusionsThe virtual and/or low-touch behavioral intervention components tested are acceptable and feasible and show enough potential to warrant refinement and testing in future research, particularly the lottery prize. Results must be interpreted in the context of the COVID-19 pandemic.Trial registrationNCT04518241 (https://clinicaltrials.gov/ct2/show/NCT04518241).

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Effects of Behavioral Intervention Components for African American/Black and Latino Persons Living with HIV with Non-suppressed Viral Load Levels: Results of an Optimization Trial

et al. 2023

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Correction: Advancing behavioral interventions for African American/Black and Latino persons living with HIV using a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory: a qualitative exploratory study

Cited by 3 publications

References 1 publication

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV

Understanding why racial/ethnic inequities along the HIV care continuum persist in the United States: a qualitative exploration of systemic barriers from the perspectives of African American/Black and Latino persons living with HIV

A virtual pilot optimization trial for African American/Black and Latino persons with non-suppressed HIV viral load grounded in motivational interviewing and behavioral economics

Effects of Behavioral Intervention Components for African American/Black and Latino Persons Living with HIV with Non-suppressed Viral Load Levels: Results of an Optimization Trial

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