Factors associated with lack of care engagement among older, rural‐dwelling adults living with HIV in the United States

• Published in: The Journal of rural health 2023-03, Vol.39 (2), p.477-487
• Main Authors: Petroll, Andrew E., Quinn, Katherine G., John, Steven A., Nigogosyan, Zack, Walsh, Jennifer L.
• Format: Article
• Language: English
• Subjects: adherence; Adult; Adults; Aging; Comorbidity; Cross-Sectional Studies; Delivery of Health Care; engagement; Female; Health care; Health research; Health services; HIV; HIV Infections - epidemiology; HIV Infections - psychology; HIV Infections - therapy; Human immunodeficiency virus; Humans; Internet access; Intervention; Living alone; Low income groups; Male; Medical conditions; Medical technology; Medicine; Mental disorders; Mental health; Mental Health Services; Middle Aged; Mortality rates; Multiple regression analysis; older adult; Older people; Polls & surveys; Privacy; Quality of care; Quality of life; Quality of Life - psychology; Regression analysis; rural; Rural areas; Rural communities; Rurality; Social interactions; Social isolation; Social support; Stigma; Substance abuse; Substance use; Surveys; United States - epidemiology; Women
• ISSN: 0890-765X; 1748-0361; 1748-0361
• DOI: 10.1111/jrh.12732

Purpose Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50. Methods We conducted a cross‐sectional study to evaluate the association between patient‐level factors and a combined outcome variable encompassing multiple aspects of care engagement. Findings Either online or on paper, 446 participants completed our survey. One‐third of the participants (33%) were from the southern United States; one‐third were women; one‐third were non‐White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care. Conclusions Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.