Back to Annual Meeting

Back to Annual Meeting

APHA Scientific Session and Event Listing

Howard Cabral, PhD¹, Michael Relf, PhD², Nancy Blaney, PhD³, Serena Rajabiun, MPH⁴, Casey Rebholz, BA⁵, and Carol Tobias, MMHS⁴. (1) Department of Biostatistics, Boston University School of Public Health, 715 Albany Street, Talbot Bldg., Boston, MA 02118, 617-414-5251, hjcab@bu.edu, (2) School of Nursing and Health Studies, Georgetown University, 3700 Reservoir Road NW, Washington, DC 20057-1107, (3) Department of Psychiatry, University of Miami Miller School of Medicine, 1695 N.W. 9th Avenue, 3rd Floor, P.O. Box 016960 (D-29), Miami, FL 33101, (4) Health and Disability Working Group, Boston University School of Public Health, 374 Congress St., Suite 502, Boston, MA 02210, (5) Boston University School of Public Health, Health and Disability Working Group, 374 Congress St., Suite 502, Suite 502, Boston, MA 02210

Background: Little is known about the process of engagement in HIV primary care among patients who are hard-to-reach. We used structural equations models (SEM) on data obtained from interviews with 1008 patients enrolled in a national multi-site outreach demonstration project to test a theory underlying this process. These patients were largely male (58%), African-American (58%) or Latino (22%), reported a recent need for mental health services (50%), and had a history of binge drinking (68%) or injection drug use (34%). Methods: Our theoretical model involved 7 hypothesized latent factors: individual contextual factors; barriers; facilitators; care history; adherence; retention; and connectedness. We examined the components of each latent factor in preliminary factor analyses and constructed the SEM by fitting simple models and progressing to more complex models, eliminating non-significant components. Results: The final SEM contained 2 predictor variables, a score measuring engagement with the patient's primary care provider and the history of illicit drug use or mental health problems (a latent factor). These predictors defined a latent outcome factor, engagement in HIV primary care. This factor was in turn predictive of having a regular provider or place for HIV primary care and having obtained HIV primary care in the prior 6 months. Conclusions: Data on the psycho-social contextual and functional aspects of HIV disease can be used to augment measurement of engagement in care via utilization variables. Research of this type should also be supplemented by information from carefully designed qualitative research.

Learning Objectives: At the conclusion of this session, participants will be able to

• Better understand the relationship of psycho-social contextual and functional aspects of HIV disease and utilization variables and how they can be used to measure engagement in HIV primary care;
• Discern the distinction between a theoretical and a data-based model in the context of the process of engagement in HIV primary care.

Keywords: HIV Interventions, Health Care Delivery

Presenting author's disclosure statement:

Not Answered