Melissa Ward-Peterson

This study seeks to inform emergency preparedness efforts by summarizing the pandemic’s impacts on access to opioid use disorder (OUD) recovery support as reported by women in recovery. In-depth interviews were completed with adult women in recovery from OUD. We used a primarily deductive approach to coding and analysis. Two coders analyzed transcripts; discrepancies were resolved through discussion. Seventeen women completed interviews from June to October 2020. Pandemic impacts primarily focused on engagement in care and retention at community and interpersonal levels. Community-level barriers to engagement included facilities’ halting intake of patients and fear of COVID-19 infection in treatment settings. Interpersonal barriers to engagement included loss of childcare support and the sudden transition to virtual services. Community-level retention barriers included perception of facility staff’s lack of adherence to infection prevention protocols and strict enforcement of infection prevention protocols on residents within facilities. Interpersonal barriers to retention included reduced availability of mutual aid meetings. Participants also highlighted how the pandemic worsened the addiction crisis and increased women’s caretaking burden. Leaders and administrators must be prepared to simultaneously balance responses for two public health crises: a novel infectious disease and addiction. Lessons learned from the pandemic can mitigate barriers to care and recovery when future emergencies arise.

To assess the impact of changes in barriers to HIV viral suppression and the moderating role of patient-provider relationships, we conducted a retrospective cohort study using dynamic causal Bayesian network analyses on the first two available needs assessments between May 2020 and December 2022 for clients of the Miami-Dade County Ryan White Program (RWP) Part A Program. A cohort of 1539 individuals was formed using data from the RWP medical case management dataset. These records were merged with summary patient-centered care measures of their provider that were obtained from an earlier survey of clients in the program. Of the 1539 individuals in the longitudinal cohort, 86.2% were virally suppressed at time point 1 and 87.5% at time point 2. At time point 2, 144 (9.4%) were newly suppressed, and 124 (8.1%) were newly non-suppressed. Of the modifiable factors assessed, drug use and tobacco use significantly predicted a low probability of viral load suppression, while provider rating and provider’s Health Care Relationship Trust Score significantly predicted a high probability of viral load suppression, although the associations with drug use and tobacco use were stronger than those with any provider variables. Results highlight the need for interventions promoting strong patient-provider relationships and targeting reductions in tobacco and illegal drug use with priorities based on the prevalence of tobacco and illegal drug use within specific RWP client populations.

This study examined barriers to accessing treatment and recovery support for opioid use disorder (OUD) among women and suggested solutions to overcoming them. Ten in-depth focus groups (27 participants) were conducted with women in recovery from August 2023 to January 2024. Transcripts were analyzed by two coders using an inductive approach guided by grounded theory methods. Major themes that emerged highlighted the ways compounding challenges make accessing treatment and entering recovery difficult, as well as the unique hardships encountered by mothers. Themes related to potential solutions included fostering supportive communities of women, improving the availability of gender-specific resources and support, and providing comprehensive, individualized recovery services. Further research on implementation strategies is needed to integrate these suggestions into treatment and recovery settings. Moving forward, it is critical that the hard-won victories of women in recovery are directly translated into action to improve OUD treatment and recovery settings for women.

We conducted a cross-sectional study to examine the associations between items of the patient-provider relationship measures and antiretroviral therapy (ART) adherence and viral suppression within each of three ethnic groups of women with HIV (WHIV) - Hispanic, Haitian, and African American - using data from 542 WHIV enrolled in the Miami-Dade County Ryan White Program. Univariate and multivariable logistic regression models were applied for each patient-provider relationship variable, stratified by race/ethnicity. Overall, 71.9% of participants were adherent to ART, and 91.2% had suppressed viral loads. Among Haitian women, patient involvement in HIV care decision-making was associated with increased adherence to ART. For African American women, ART adherence was positively associated with providers spending adequate time with patients, showing respect, listening carefully, and considering their need for privacy. Among Hispanic women, ART adherence was positively associated with providers asking about difficulties in managing health, spending adequate time, listening carefully, and involving patients in decision-making. Additionally, providers spending enough time with the patient and expressing interest in the patient as a person were strongly associated with viral suppression among Hispanics. Findings highlight the critical role of culturally sensitive, patient-centered care in promoting ART adherence and viral suppression among racial and ethnic minority WHIV.

We assessed the role of patient-centered care on durable viral suppression (i.e., all viral load test results < 200 copies per ml during 2019) by conducting a retrospective cohort study of clients medically case managed by the Miami-Dade County Ryan White Program (RWP). Summary measures of patient-centered care practices of RWP-affiliated providers were obtained from a survey of 1352 clients. Bayesian network models analyzed the complex relationship between psychosocial and patient-centered care factors. Of 5037 clients, 4135 (82.1%) had durable viral suppression. Household income was the factor most strongly associated with durable viral suppression. Further, mean healthcare relationship score and mean “provider knows patient as a person” score were both associated with durable viral suppression. Healthcare relationship score moderated the association between low household income and lack of durable viral suppression. Although patient-centered care supports patient HIV care success, wrap around support is also needed for people with unmet psychosocial needs.

Background: Patient-centered care (PCC) improves HIV adherence and retention, though lack of consensus on its conceptualization and understanding how it is interpreted has hindered implementation. Methods: We recruited 20 HIV providers at Ryan White Programs in FL for in-depth interviews. Thematic analysis identified core consistencies pertaining to: 1) provider perceptions, 2) current practices promoting PCC. Results: Provider perceptions of PCC emerged under four domains: 1) holistic, 2) individualized care, 3) respect for comfort and security, and 4) patient engagement and partnership. PCC practices occurred at multiple levels: 1) individual psychosocial and logistical support, 2) interpersonal support within patient-provider relationships through respectful communication and active engagement, and 3) institutional practices including feedback mechanisms, service integration, patient convenience, and diverse staffing. Conclusions: Our findings highlight the central tenets of PCC as respectful, holistic, individualized, and engaging care. We offer an HIV-adapted framework of PCC as a multilevel construct to guide future intervention.

This study examined factors associated with self-reported ART nonadherence during the COVID-19 pandemic among Miami-Dade County Ryan White HIV/AIDS Program (RWHAP) clients. A cross-sectional survey was conducted from October 2020-January 2021 in English, Spanish, and Haitian Creole. The survey included questions on self-reported ART adherence, HIV care access (compared to before the pandemic), social and economic pandemic impacts, and demographics. We carried out descriptive bivariate analyses and weighted logistic regression to estimate unadjusted and adjusted odds ratios (aORs) for self-reported nonadherence. 12.7% of participants reported ART nonadherence. Adjusting for age, sex, race/ethnicity, and nativity, factors associated with nonadherence included greater difficulty accessing an HIV doctor compared with before the COVID-19 pandemic (aOR=3.6, 95% CI: 1.4–9.2) and experiencing financial impacts due to the pandemic (aOR=4.2, 95% CI: 1.5–12.2). Ensuring RWHAP clients maintain access to HIV medical care providers and receive support for financial shocks are critical to sustaining ART adherence.