Healthcare Utilization, Unmet Service Needs, and HIV Treatment Outcomes among People Living With HIV/AIDS in Nevada
AdvisorOman, Roy F
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Comorbidity rates and service needs are high among people living with HIV/AIDS (PLWHA). The effects of service utilization and unmet service needs on HIV treatment outcomes are not well understood. Furthermore, health disparities among racial/ethnic groups exist across the stages of HIV care continuum. Racial/ethnic differences in service utilization and HIV treatment outcomes are also not well explored. The purpose of this dissertation is to use Andersen’s Behavioral Model of Health Service Use (ABM) as a theoretical framework to conceptualize and explain the associations between service utilization, unmet service needs, and HIV treatment outcomes, as represented by antiretroviral therapy (ART) adherence and linkage to care, among PLWHA; and to investigate possible race/ethnicity differences in service utilization, unmet service needs, and HIV treatment outcomes. Multivariable logistic regression analyses were conducted to examine associations between service utilization, unmet service needs, and ART adherence and linkage to care. Significant race/ethnicity differences regarding service utilization, linkage to care and medication adherence were assessed using multiple linear regression and multiple logistic regression models. Using a sample of 177 PLWHA in Nevada, this dissertation demonstrated that unmet services needs were significantly negatively associated with ART adherence. No significant association was found between service utilization and linkage to care. However, participants who reported late linkage to care also reported needing more help obtaining health insurance and a greater need for support groups compared to participants who reported timely linkage to care. In addition, significant racial/ethnic differences were observed for seven individual services, including medical care, mental health care, case management, HIV and health classes, financial help, help understanding medicines, and help filling out forms. Collectively, the findings contribute to the HIV healthcare service utilization literature by showing a direct association between unmet service needs and ART adherence. The results demonstrated that health disparities do exist among racial/ethnic groups in specific healthcare services. The results can inform interventions that aim to address specific service needs and improve healthcare services for certain racial/ethnic groups. Furthermore, the study informs programs and policies that allocate health services and deliver needed services to maximize the benefits of HIV care.