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dc.contributor.advisorSousa, Karen H.
dc.contributor.advisorCook, Paul F.
dc.contributor.authorMignano, Jamie Lynn
dc.contributor.committeememberHarpin, Scott
dc.contributor.committeememberMugavero, Michael
dc.date.accessioned2018-12-14T17:18:51Z
dc.date.available2020-12-13T17:18:54Z
dc.date.submitted2018
dc.descriptionIncludes bibliographical references.
dc.descriptionFall
dc.description.abstractDespite widespread attention to the HIV care continuum over the past several years, little attention has focused on the 45% of PLWH that are not retained in care who are responsible for more than 60% of new HIV infections. The gaps in the HIV care continuum are further compounded by the disproportionate burden of HIV among individuals affected by social and economic disparities. The purpose of the study was to identify potential community level and individual level characteristics of re-linkage to HIV care among out of care people living with HIV (PLWH). Andersen’s Behavioral Model (ABM), a health services research model that describes access and use of health care in vulnerable populations, was the theoretical framework applied in the study. A two-level generalized linear model was used to test the constructs of ABM and their association with re-linkage to outpatient HIV care after a gap in care of six months or more among out of care, hospitalized PLWH. A total of 328 hospitalized PLWH encountered at two urban hospitals from 2013-2016 nested in 12 zip codes were included in the study. Community data at the zip code level was obtained from the American Community Survey (2010-2014) and the Maryland HIV Epidemiologic Report (2013). Composite scores for socioeconomic disadvantage were created based on the mean of five tested measures using regression methodology. Zip code level HIV prevalence was also tested. The intraclass correlation coefficient, derived from the unconditional model was 0, indicating no significant clustering by zip code. However, the multi-level framework was maintained for the bivariate and multivariate analyses based on the study’s theoretical model. The final model indicated that participants with a non-IDU associated risk factor, without a substance use history and with stable housing are more likely to re-link to HIV care after hospitalization (intercept = -0.7139) than individuals with these characteristics and re-linking based on the unconditional model (intercept = -0.1834). The predicted probably of re-linkage to care was 0.70 in the conditional model, versus 0.54 in the unconditional model. The deviance test between two models indicated a better fit in the conditional model (X2diff = 16.26). This study identified characteristics of re-linkage to HIV care after hospitalization among PLWH who are out of care in Baltimore, Maryland. Some findings are consistent with research pertaining to other parts of the HIV care continuum, however, the results of this study indicate that re-linkage is its own concept and perhaps its own stage of the HIV care continuum. Future research that covers a broader geographic base is needed to determine if there is zip-code level effects on re-linkage to HIV care. Furthermore, future research should examine longitudinal HIV care continuum outcomes (i.e. retention, viral suppression) after re-linkage to care. Other measures should be considered as part of the ABM framework, in order to better understand the concept of re-linkage to HIV care. Finally, operations research is needed to test interventions in this population based on research findings.
dc.identifierMignano_ucdenveramc_1639D_10583.pdf
dc.identifier.urihttps://hdl.handle.net/10968/3092
dc.languageEnglish
dc.publisherUniversity of Colorado Anschutz Medical Campus. Strauss Health Sciences Library
dc.rightsCopyright of the original work is retained by the author.
dc.subjectengagement
dc.subjectre-linkage
dc.subject.meshHIV
dc.subject.meshContinuity of Patient Care
dc.titleRe-linkage to HIV care among persons living with HIV (PLWH) with a gap in care of six months or more
dc.typeThesis
thesis.degree.disciplineNursing
thesis.degree.grantorUniversity of Colorado at Denver, Anschutz Medical Campus
thesis.degree.levelDoctoral
thesis.degree.nameDoctor of Philosophy (Ph.D.)


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