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AIDS Behav. 2018 Aug;22(8):2604-2614. doi: 10.1007/s10461-018-2092-7.

Health Literacy and Demographic Disparities in HIV Care Continuum Outcomes.

Author information

1
Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, 1161 21st Avenue S., A-2200 MCN, Nashville, TN, 37232, USA. p.rebeiro@vanderbilt.edu.
2
Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, NY, USA.
3
Institute for Medicine and Public Health, Center for Effective Health Communication, Vanderbilt University School of Medicine, Nashville, TN, USA.
4
Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, 1161 21st Avenue S., A-2200 MCN, Nashville, TN, 37232, USA.
5
Indiana University School of Medicine, Bloomington, IN, USA.
6
Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
7
Division of General Internal Medicine and Public Health, Vanderbilt University School of Medicine, Nashville, TN, USA.

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.

KEYWORDS:

ART adherence; Health literacy; Human immunodeficiency virus; Retention in care; Viral suppression

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