Disparities in HIV/AIDS: Examining Retention in Care and Health Literacy Restricted; Files & ToC

Anderson, Ashley N. (Spring 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/5999n4533?locale=en



Low health literacy and poor retention in care contribute to HIV health disparities among African Americans, but causal pathways have not been examined. We employed an adapted health literacy model to examine the role of health literacy on racial disparities in retention in care and HIV outcomes.


Participants included 699 HIV-positive adults receiving care at one of four HIV clinics in metro-Atlanta, Georgia. We used path analysis to test the mediating effect of 1) health literacy between race (African American vs. non-African American) and retention in care; 2) retention in care between health literacy and HIV viral load; 3) health literacy between sociodemographic indicators and patient-provider interactions. Retention in care was operationalized as 100% visit adherence versus less than 100% visit adherence. Measures included the Short-Test of Functional Health Literacy and the Attitudes Towards the HIV Health Care Provider Scale. Data were collected from 2012 to 2015 through face-to-face interviews. Retention in care and viral load data were abstracted from electronic medical records 24-months post survey.


Average participant age was 48 years, with 60% African American and 92% virally suppressed. Non-African American race (p = .028) was related to greater health literacy. Greater health literacy led to 100% visit adherence (p = .002), which was subsequently associated with viral suppression (p < .001). Socioeconomic status (p = .013) and cognitive function (p < .001) directly influenced health literacy, which then influenced 100% visit adherence and patient-provider interactions (p < .001). The model demonstrated good fit (RMSEA = 0.002, SRMR = 0.042, CFI = 0.999, TLI = 1.003).


Health literacy mediates the relationship between race and retention in care, as well as the effect of race and sociodemographic predictors on patient-provider interactions. Findings suggest causal pathways between retention in care and health literacy for racially disparate HIV populations. Findings from this study highlight areas of research that may expand knowledge of health literacy on disparities in retention in care. Additional implications include the need to provide individualized, patient-centered educational health resources and retention in care interventions that address patient health literacy.

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