PROJECT SUMMARYAchieving high rates of retention in human immunodeficiency virus (HIV) care and adherence to antiretroviraltherapy leads to high rates of viral suppression, which not only reduces mortality and improves quality of living,among people living with HIV infection, but also reduces HIV transmission within affected communities. HIVcare outcomes among women have been suboptimal; in 2014, viral suppression was 52.6% among AfricanAmericans, 57.9% among Whites, and 59.8% among Latinas compared with 66.0% among White men.Women living with HIV infection are more likely to face barriers to successful HIV care such as child careburden, abuse, and extreme poverty than men. In addition, women, in particular women of color, can facemultiple layers of stigma including those related to their race, ethnicity, HIV infection, drug use, and povertystatus. Partly because the HIV epidemic initially affected mostly men, the HIV care system is not designed tomeet women's special needs. Implementing women-centered HIV care has been proposed nationally andinternationally as a way to address women's needs. However, this idea has not been well operationalized forHIV care and has not been examined in the context of the United States health care system including the RyanWhite Program, which serves 65% of women living with HIV in the United States. Our central hypothesis is thatthe more women-centric a system is, the higher the likelihood of HIV care retention and viral suppressionamong women. The objective of this application is to identify effective provider and system women-centeredHIV care practices within the Ryan White Program that positively influence HIV care retention and viralsuppression among women experiencing sociocultural challenges. We will accomplish this objective with amixed methods study examining patient intake and billing data from women enrolled in the Miami-Dade CountyRyan White Program, conducting in-depth interviews with case managers, health care providers,administrators, and women living with HIV, and conducting a survey of 600 women living with HIV in the Miami-Dade County Ryan White Program. We propose the following three specific aims: 1) Identify socioculturalfactors that influence HIV care retention and viral suppression, including those unique to women and thosehaving a differential impact on African American, Haitian and Latina women; 2) Ascertain current and potentialhealth care provider and system women-centered HIV care practices that may mitigate the effect of adversesociocultural factors on HIV care retention and antiretroviral therapy adherence; 3) Identify specific health careprovider and system women-centered HIV care practices that most strongly influence HIV care retention,adherence, and viral suppression among all women and in African American, Haitian and Latina women. Thisproject addresses the National HIV/AIDS Strategy goals to increase access to care, improve health outcomes,and reduce HIV-related health disparities and the Trans-NIH Plan for HIV-Related Research call for researchto promote HIV care engagement and to reduce disparities in treatment outcomes.
