Understanding Medical Distrust Among African American/Black and Latino Persons Living With HIV With Sub-Optimal Engagement Along the HIV Care Continuum: A Machine Learning Approach

He, Ning; Cleland, Charles M.; Gwadz, Marya; Sherpa, Dawa; Ritchie, Amanda S.; Martinez, Belkis Y.

doi:10.1177/21582440211061314

Cited by 10 publications

(5 citation statements)

References 94 publications

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“…For example, Black and Hispanic/LatinX PLWH often have lower trust in health care compared to White patients, which can manifest as distrust in providers. 24 Increasing patient trust of their HIV provider may improve RIC and viral suppression rates among non-White patients. Improving providers’ cultural competence could potentially promote this.…”

Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in HIV care outcomes among insured patients at a large urban sexual health clinic

Mathai

Hinestrosa

DeJesus

et al. 2023

Journal of Investigative Medicine

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Prior studies demonstrate that non-White patients are less likely to achieve human immunodeficiency virus (HIV) suppression compared to White patients due to lack of health insurance. This study aims to determine whether racial disparities in the HIV care cascade persist among a cohort of privately and publicly insured patients. This retrospective analysis evaluated HIV care outcomes during the first year of care. Eligible patients were aged 18–65 years, treatment-naïve, and seen between 2016 and 2019. Demographic and clinical variables were extracted from the medical record. Differences in the proportion of patients achieving each HIV care cascade stage by race were evaluated using unadjusted chi-square testing. Risk factors for viral non-suppression at 52 weeks were analyzed using multivariate logistic regression. We included 285 patients; ninety-nine were White, 101 were Black, and 85 identified as Hispanic/LatinX ethnicity. Significant differences in retention in care for Hispanic/LatinX patients (odds ratio (OR): 0.214, 95% confidence interval (CI): 0.067–0.676) and viral suppression for both Black (OR: 0.348, 95% CI: 0.178, 0.682) and Hispanic/LatinX patients (OR: 0.392, 95% CI: 0.195, 0.791) compared to White patients were observed. In multivariate analyses, Black patients were less likely to achieve viral suppression compared to White patients (OR: 0.464, 95% CI: 0.236, 0.902). This study showed that non-White patients were less likely to achieve viral suppression after 1 year despite insurance and suggests that other unmeasured factors may disproportionately affect viral suppression in these patients. Interventions to identify and address these factors are needed to improve HIV care outcomes for non-White populations.

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Section: Discussionmentioning

confidence: 99%

Racial/ethnic disparities in HIV care outcomes among insured patients at a large urban sexual health clinic

Mathai

Hinestrosa

DeJesus

et al. 2023

Journal of Investigative Medicine

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“…Further, relationships between AABL-PLWH and providers are shaped by treatment perspectives that prioritize total abstinence from substance use, and similarly, the expectation of taking HIV medication "every dose, every day." Indeed, experiencing medical distrust and counter-narratives, and commonly trust their providers more than health care systems [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…At the individual/attitudinal level of in uence, primary barriers to engagement along the HIV care continuum include fear and distrust of HIV medications, of the health care system and medical settings, and to a lesser extent, of providers [24]. Counter-narratives about the causes and treatments of HIV (called conspiracy theories in some cases) are another aspect of distrust [24,25]. Other barriers include substance use and mental health concerns [26][27][28][29].…”

Section: Multi-level Factors Cause Poor Engagement Along the Hiv Care...mentioning

confidence: 99%

Advancing behavioral interventions for African American/Black and Latino persons living with HIV by integrating critical race theory, harm reduction, and self-determination theory: A qualitative exploratory study

Gwadz

2022

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Background . Rates of participation in HIV care, medication uptake, and viral suppression are improving among persons living with HIV (PLWH) in the United States. Yet, racial/ethnic disparities in engagement along this HIV care continuum are persistent, particularly among African American/Black and Latino PLWH, signaling the need for novel approaches. We created a new conceptual model that integrates critical race theory, harm reduction, and self-determination theory, which was used to plan an intervention optimization trial to test five behavioral intervention comcompponents. The present qualitative exploratory study describes the integrated conceptual model (ICM) and explores participants’ perspectives on contributions of the ICM to study acceptability, feasibility, and impact. Methods . Participants were African American/Black and Latino PLWH poorly engaged in HIV care and with non-suppressed HIV viral load in New York City. From the parent optimization trial (N=512), we randomly selected 46 for in-depth semi-structured interviews on experiences in the optimization trial. Interviews were audio-recorded and professionally transcribed verbatim, and data were analyzed using directed qualitative content analysis. Results . On average, participants were 49 years old (SD=9) and had lived with HIV for 19 years (SD=7). Most were male (78%) and African American/Black (76%). All had taken HIV medication previously. Challenging life contexts were the norm comprised of poverty, poor quality/unstable housing, trauma histories exacerbated by current trauma, medical and mental health comorbidities, and substance use. Participants found the optimization trial highly acceptable. We organized results into four themes focused on the importance of 1) being understood as a whole person and in context; 2) trustworthiness and trust; 3) opportunities for self-reflection; and 4) support of personal autonomy. The salience of nonjudgment was prominent in each theme. Their experiences and perspectives reflected the ICM. Participants reported these characteristics were generally lacking in HIV care settings. Conclusions . The ICM for is a new useful model for research with AABL-PLWH with potential to enhance study acceptability, feasibility, and intervention effectiveness. Future application of the ICM is warranted to reduce racial/ethnic disparities. In a future study, we will explore participants’ perspectives on the specific intervention components in which they engaged and ways components can be improved.

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“…High levels of medical distrust are associated with reduced utilization of preventive health services, delays in seeking care, and lower treatment adherence [4][5][6]. Consequently, medical distrust can have detrimental effects on an individuals' self-reported health, mental health, and overall satisfaction with their healthcare experiences [7][8][9]. Kidney transplant (KT) candidates must regularly engage with the healthcare system as part of their management for end-stage kidney disease (ESKD).…”

Section: Introductionmentioning

confidence: 99%

Medical Distrust Among Kidney Transplant Candidates

Thompson,

Li,

Liu

et al. 2024

Clinical Transplantation

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BackgroundMedical distrust may hinder kidney transplantation (KT) access. Among KT candidates evaluated for waitlisting, we identified factors associated with high distrust levels and quantified their association with waitlisting.MethodsAmong 812 candidates (2018–2023), we assessed distrust using the Revised Health Care System Distrust Scale across composite, competence, and values subscales. We used linear regression to quantify the associations between candidate and neighborhood‐level factors and distrust scores. We used Cox models to quantify the associations between distrust scores and waitlisting.ResultsAt KT evaluation, candidates who were aged 35–49 years (difference = 1.97, 95% CI: 0.78–3.16), female (difference = 1.10, 95% CI: 0.23–1.97), and Black (difference = 1.47, 95% CI: 0.47–2.47) were more likely to report higher composite distrust score. For subscales, candidates aged 35–49 were more likely to have higher competence distrust score (difference = 1.14, 95% CI: 0.59–1.68) and values distrust score (difference = 0.83, 95% CI: 0.05–1.61). Race/ethnicity (Black, difference = 1.42, 95% CI: 0.76–2.07; Hispanic, difference = 1.52, 95% CI: 0.35–2.69) was only associated with higher values distrust scores. Female candidates reporting higher rescaled values distrust scores (each one point) had a lower chance of waitlisting (aHR = 0.78, 95% CI: 0.63–0.98), whereas this association was not observed among males. Similarly, among non‐White candidates, each 1‐point increase in both rescaled composite (aHR = 0.87, 95% CI: 0.77–0.99) and values (aHR = 0.82, 95% CI: 0.68–0.99) distrust scores was associated with a lower chance of waitlisting, while there was no association among White candidates.ConclusionFemale, younger, and non‐White candidates reported higher distrust scores. Values distrust may contribute to the long‐standing racial/ethnic and gender disparities in access to KT. Implementing tailored strategies to reduce distrust in transplant care may improve KT access for groups that experience persistent disparities.

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Understanding Medical Distrust Among African American/Black and Latino Persons Living With HIV With Sub-Optimal Engagement Along the HIV Care Continuum: A Machine Learning Approach

Cited by 10 publications

References 94 publications

Racial/ethnic disparities in HIV care outcomes among insured patients at a large urban sexual health clinic

Racial/ethnic disparities in HIV care outcomes among insured patients at a large urban sexual health clinic

Advancing behavioral interventions for African American/Black and Latino persons living with HIV by integrating critical race theory, harm reduction, and self-determination theory: A qualitative exploratory study

Medical Distrust Among Kidney Transplant Candidates

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