Trust in providers and health care systems (HCSs) was associated with higher human immunodeficiency virus (HIV) antiretroviral therapy (ART) adherence. However, according to a report in AIDS Patient Care and STDs, the studies that identified the association primarily enrolled male participants and did not assess provider trust, HCS distrust, and clinical and biological outcomes as a whole. As such, Katherine G. Michel, PhD, MPH, from the Division of Infectious Diseases of the Department of Medicine at Georgetown University Medical Center in Washington, D.C., and collaborators surveyed women on provider and HCS trust and distrust. They found that self–reported ART adherence was significantly associated with not only high provider trust, but also with high HCS distrust.

The study enrolled 167 WWH and 72 women without HIV from the DC Women’s Interagency HIV Study (WIHS). The participants had completed provider trust and HCS distrust surveys, and their clinical, social, and demographic factors were reported. The majority of women were African American/black (76.9%) with a median age of 62 (interquartile range [IQR]: 48–58), and 99.6% were currently insured.

After their analysis, the investigators found that WWH had greater odds of high provider trust (adjusted odds ratio [aOR] = 2.90; 95% confidence interval [CI], 1.34–6.45). Furthermore, ≥95% adherence to ART was associated with high provider trust only in the WWH group (aOR = 4.13; 95% CI, 1.14–15.92). Interestingly, multi–variable modelling revealed 3.40–point higher scores for HCS distrust among the WWH who self–reported ≥95% ART adherence (p = 0.03).

Differing CD4 counts and HIV viral loads were not associated with either provider trust or HCS distrust. Lastly, provider (p = 0.67) and HCS (p = 0.65) trust did not significantly change at two time points for 10 years in the patients.

The study’s authors concluded that high provider trust, yet also high HCS distrust, were both associated with greater self–reported ART adherence. The report surmised that the seemingly at–odds associations illuminate “a nuanced relationship to providers and the HCS among WWH.”

 

Source: AIDS Patient Care and STDs

https://www.liebertpub.com/doi/10.1089/apc.2021.0110