by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer
April 26, 2022
This review was undertaken to help contribute to a more nuanced, comprehensive understanding of how health literacy impacts HIV-related health behaviors for groups experiencing disproportionately high HIV incidence, with specific attention to psychosocial and other contextual factors that may mediate relationships between race/ethnicity, health literacy, and HIV outcomes. 14 quantitative and 3 qualitative studies met inclusion criteria and examined whether health literacy was associated with retention in HIV care and/or ART adherence. Among 11 quantitative studies exploring the association between health literacy and adherence, 64% found a significant association. Two of four quantitative studies found a significant association between health literacy and retention in HIV care. One study including an analysis of stigma observed that HIV-related perceived stigma partially mediated the relationship between health literacy and medication adherence. Two studies observed that self-efficacy was associated with health literacy and influenced retention in care and ART adherence. One study examining participants’ beliefs regarding likelihood of a positive outcome observed that PWH with increased positive outcomes expectancy were more likely to have 100% medication adherence and more likely to attend all physician visits. Findings from one qualitative study suggested trust between patients and providers built over time was one of the most important aspects of care.
Investigators note “there has been a shift from focusing on individual behavioral modifications to addressing the important systemic changes needed in healthcare delivery to achieve greater equity for PWH”, acknowledging the potentially important role of organizational (rather than personal) health literacy in the HIV epidemic. Because patients’ level of trust affects both health literacy and HIV outcomes, providers/systems may benefit from identifying opportunities to become more trustworthy. Findings of this review also suggest internalized or perceived HIV-related stigma affects how PWH receive and integrate information about their HIV care and highlight the roles structural HIV stigma and provider attitudes/behaviors play. A greater understanding of relationships within the network of these complex factors may help care systems identify how to provide care experiences that lead to positive interactions and outcomes for all patients.
The author has no conflicts of interest to disclose.
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