Predictors and social determinants of HIV treatment engagement among post-partum Black women living with HIV in southeastern United States.

AIM: Guided by Mcleroy's socio-ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post-partum women living with HIV. METHOD: Quantitative, research methodology. DESIGN: We conducted a retrospective, secondary data analysis of 143 Black post-partum women living with HIV who received peripartum care in South-Florida, United States, from 2009 to 2017. We examined odds of immediate post-partum engagement at 3 months post-partum, and ongoing primary care engagement at 12 months post-partum. RESULTS: The independent group analyses showed low levels of immediate post-partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post-partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post-partum engagement. Also, immediate post-partum disengagement was a significant predictor for ongoing primary care disengagement. CONCLUSION: This study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities. IMPACT: The study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at-risk women and intervene accordingly to ensure that their care is not marginalized. PATIENT/PUBLIC CONTRIBUTION: This study includes direct patient data from Black post-partum women living with HIV who were seen at prenatal and post-partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service-users, who further corroborated our findings, and provided insights and future recommendations.

Being Lost to Follow-Up to Healthcare Appointments: A Concept Analysis.

The concept of being lost to follow-up is very common in healthcare. Though its meaning might seem literal, its use, particularly in healthcare, requires detailed analysis, to understand factors surrounding its incidence and ways of curtailing its detrimental consequences. Walker and Avant's eight-step concept analysis was used to identify the antecedents, attributes, empirical referents, and consequences of this concept. The attributes of the concept include a clinical starter event suffered by a patient that requires ongoing evaluation by an event tracker at a given location and frequency. However, despite a mutual agreement between the patient and the event tracker, the evaluation suffers a hiatus due to several modifiable and nonmodifiable risk factors (antecedents of the concept), consequences which might include morbidity and death. Early identification and intervention are critical to avoid the occurrence of being lost to follow-up, and nurses need to be cognizant of such knowledge.