Date of Award

Fall 1-9-2015

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Richard Rothenberg, MD, MPH

Second Advisor

Natalie Crawford, Ph.D., MPH

Third Advisor

Jane Kelly, MD

Abstract

Introduction: Behavioral and medical interventions such as syringe exchange and anti-retroviral therapy have been successful in reducing the incidence and transmission of HIV and improving the longevity and quality of life of people with HIV/AIDS. However, there are an estimated 1.1 million people living with HIV in the United States and only about 37% are retained in some form of HIV care. People living with HIV often have multiple comorbidities and other challenges that often require specialty care.

Methods: We used data from the Medical Monitoring Project to assess HIV-related supportive service needs among people living with HIV in Georgia to understand whether there is an unmet need in this sample (n = 417). Descriptive tables and Chi-square tests were used to assess differences in types of HIV-related services needed and actually utilized by Blacks and Non-blacks. Bivariate and Multivariable logistic regression was performed to assess correlates of having at least one unmet need.

Results: The cross-section was a probability-based sample of people living with HIV/AIDS in Georgia. Blacks were more likely to need Preventative Education and Mental Health counseling than Non-blacks. Despite no significant difference in the need of ART Adherence Support between Blacks and Non-blacks, Blacks significantly had more unmet ART Adherence Support needs when compared to Non-blacks (p = 0.0097). Bivariate analysis showed those with a high school education and those who have experience homelessness were more likely to have unmet service needs (OR = 1.75 95% CI = 1.06 – 1.89) and (OR = 2.97 95% CI = 1.22 – 7.23) respectively. A multivariable logistic model correcting for potential confounding showed those who have experienced homelessness were more likely to have unmet service needs (OR = 2.49 95% CI = 1.02 – 6.11). The most cited reasons for not receiving a service need were Financial Barriers and Lack of Information.

Discussion: Marginalized groups exhibit greater need for supportive services and within these groups, a disparate proportion exhibit unmet needs compared to others. This analysis provides a programmatic framework to initiate better-focused efforts for sub-groups who exhibit more unmet needs.

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