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Rapid or Immediate ART, HIV Stigma, Medical Mistrust, and Retention in Care: An Exploratory Mixed Methods Pilot Study

Authors
  • Mgbako, Ofole
  • Loughran, Claire
  • Mathu, Rachel
  • Castor, Delivette
  • McLean, Jacob
  • Sobieszczyk, Magdalena E.
  • Olender, Susan
  • Gordon, Peter
  • Lopez-Rios, Javier
  • Remien, Robert H.
Type
Published Article
Journal
AIDS and Behavior
Publisher
Springer-Verlag
Publication Date
Apr 18, 2023
Volume
27
Issue
10
Pages
3430–3446
Identifiers
DOI: 10.1007/s10461-023-04058-4
PMID: 37071333
PMCID: PMC10111080
Source
PubMed Central
Keywords
Disciplines
  • Original Paper
License
Unknown

Abstract

Rapid or immediate antiretroviral therapy (iART) after HIV diagnosis improves linkage to care and time to viral suppression. However, iART may affect or be affected by HIV-related stigma and medical mistrust. In this mixed-methods pilot study, we examined the bi-directional role of HIV stigma, medical mistrust, and visit adherence (VA) in the context of iART in a diverse, newly diagnosed patient population. Participants were recruited from an HIV clinic in New York City and we utilized a convergent parallel design integrating quantitative data from demographic surveys, the HIV Stigma Survey (HIVSS), the Medical Mistrust Index (MMI) and electronic medical records, and qualitative data from in-depth interviews. Among the sample (N = 30), 26% (N = 8) initiated ART same-day or within 3 days, while the majority (N = 17) initiated between 4 and 30 days, and 17% (N = 5) initiated ART > 30 days. The median (range) age was 35, and most were English-speaking, Black or Hispanic men and identified as gay. Time to ART initiation was associated with time to linkage to care and time to viral suppression. Day 0–3 group’s major theme was iART as stigma prevention, and they had the highest mean HIVSS, lowest MMI score, and a visit adherence of 0.86. Day 4–30 group’s major theme was alleviation of internalized stigma, and they had the lowest mean HIVSS score, and highest visit adherence of 0.91. Day > 30 group’s major theme was exacerbation of perceived or anticipated stigma, had the highest MMI score and a visit adherence of 0.85. iART implementation requires equitable strategies that address HIV-stigma and mistrust. Supplementary Information The online version contains supplementary material available at 10.1007/s10461-023-04058-4.

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