Factors Associated with Retention in the Women’s Interagency HIV Study Atlanta Cohort Open Access

Abstract

Poor retention in research studies threatens the validity of findings and has negative consequences on health justice. We identified predictors of retention in the Atlanta cohort of the Women’s Interagency HIV Study (WIHS), a longitudinal observational cohort of women living with HIV and women at high-risk for HIV infection. Predictors of retention were determined through multivariable logistic regression analysis using baseline data, stratified by HIV status. With ‘retained’ defined as having attended all biannual study visits between 2013 and 2019, we found that 84% of women were retained in the cohort. Among the total cohort, history of incarceration (aOR: 4.77, CI: 1.86 – 12.22) and increased tangible social support score (aOR: 1.02, CI: 1.01 – 1.03) were predictors of retention, while drug use (aOR: 0.31) and income greater than $12,000 (aOR: 0.44, CI: 0.20 – 0.99) predicted poor retention. Among women living with HIV, only history of incarceration significantly predicted retention (aOR: 5.06, CI: 1.59 – 16.08). In a sensitivity analysis of retention among treatment-experienced participants living with HIV, history of incarceration predicted retention (aOR: 4.19, CI: 1.05 – 16.67). Among HIV-negative women, increased emotional wellbeing score predicted retention (aOR: 1.045, CI: 1.00 – 1.01) while income greater than $12,000 (aOR: 0.12, CI: 0.02 – 0.64) predicted poor retention. These results demonstrate that women of lower socioeconomic status were more likely to attend all visits than their higher income counterparts in the Atlanta WIHS cohort. These findings were contextualized through Maslow’s hierarchy of needs describing behavior as an endeavor to meet unmet needs. In order to develop more tailored retention strategies, further research should include qualitative analysis to investigate the barriers and facilitators to retention in observational research among low-income women.

Table of Contents

Chapter 1: Introduction. 1

Project Context 1

The History of HIV Research and Introduction of WIHS. 1

Atlanta WIHS and HIV in the South. 2

Retention in Vulnerable Populations. 3

Problem Statement 4

Goal 5

Chapter 2: Literature Review.. 6

Importance of Retention in Research. 6

Conceptual Frameworks. 8

Factors Associated with Study Retention. 9

Chapter 3: Manuscript 19

Introduction. 19

Methods. 20

Results. 25

Tables. 29

Discussion. 33

Cohort Description. 33

Retention Factors. 33

Conceptual Framework. 39

Limitations. 42

Chapter 4: Public Health Implications. 44

References. 48

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Epidemiology Research HIV Retention
Committee Chair / Thesis Advisor	Sophia Hussen, MD, MPH, Emory University

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