ART Adherence Linked to Patient-Centered Care From Patient-Provider Relationships

Culturally sensitive and patient-centered care is vital in assuring the adherence to antiretroviral therapy (ART) in women of different ethnic groups, according to a new study published in AIDS Care.1 Women of Hispanic, Haitian, and African American descent were more likely to be virally suppressed when met with a positive patient-provider relationship.

Patient-provider relationship was associated with adherence to ART in women of ethnic minority living with HIV | Image credit: AS Photo Family - stock.adobe.com

ART is a medication that has been shown to prolong the lives of those diagnosed with HIV, suppressing the viral load of HIV in those who take it consistently to alleviate the burden of the chronic condition. Minority women were shown to have a higher rate of diagnoses of HIV compared with White women in the US.2 This study aimed to assess adherence to ART in ethnic minority women of Hispanic, Haitian, and African American descent and evaluate its association with items of a patient-provider relationship measure.1

Participants of the study were women living with HIV and enrolled in the Miami-Dade County Ryan White Program. Women were asked if they would like to participate in the study based on previous indication that they would be interested in participating in research. Women were also eligible if they had participated in a quality improvement survey. All participants were aged 18 years or older, had been in the Ryan White Program for at least 6 months, provided consent, and spoke English, Spanish, or Haitian Creole.

The Agency for Healthcare Research and Quality Consumer Assessment of Healthcare Providers and Systems was used to assess the patient-provider relationship whereas adherence to ART was measured through self-report.

There were 542 women who were included in the study, of which 63.7% were aged 50 years or older. A total of 90.4% of the participants reported that they had their provider for a year; 88.0% of the participants rated their provider as a 9 or 10 out of 10 on the provider rating scale, with respect (96.6%) and listening (94.6%) commonly reported from their provider.

African American women were more likely to report feeling comfortable talking to their provider about personal issues compared with Haitian women (91.4% vs 14.3%) but Haitian women felt that their provider was interested in them as a person (98.7%).

A total of 71.9% of the participants were adherent to ART. Patient-provider experience was significantly associated with ART adherence in Afircan American participants when the provider spends enough time with the patient (adjusted OR [aOR], 5.22; 95% CI, 1.99-13.71), listens carefully (aOR, 11.10; 95% CI, 2.20-55.94), shows respect for the patient (aOR, 13.39; 95% CI, 1.36-132.21), and respects the need for privacy (aOR, 7.30; 95% CI, 1.32-40.40).

Hispanic women were more likely to be adherent to ART if they had a provider who listened carefully (aOR, 4.07; 95% CI, 1.28-12.94), asked about things that made it hard to be healthy (aOR, 2.09; 95% CI, 1.02-4.33), and had their provider ask about options and choices for HIV care (aOR, 3.04; 95% CI, 1.22-7.57). Haitian women also had ART adherence when asked about choices and options for HIV care by their provider (aOR, 5.22; 95% CI, 1.91-14.30).

A total of 91.2% of the participants were virally suppressed, with 95.9% of Hispanic women suppressed, 90.3% of African Americans, and 87.1% of Haitians. Viral suppression was associated with a provider spending enough time with the patient (aOR, 9.71; 95% CI, 1.87-50.40) and being interested in the patient as a person (aOR, 12.26; 95% CI, 1.89-79.45) in Hispanic women. There were no significant associations between provider relationship and adherence to ART in African American and Haitian women.

There were some limitations to this study. The participants may have had stronger relationships with their providers due to needing at least 6 months of care to participate. Participants with weaker connections to their providers may not have participated in this study. Social desirability bias is possible due to the self-reported data. All women with HIV may not be represented in this population, as most of them are from low-income houses and are of ethnic minority. Causal interpretation is also limited due to the cross-sectional design of the study.

“Overall, our study emphasizes the need for health care providers to adopt a proactive approach in patient care that fosters open dialogue to enhance patient-provider interactions, as well as patient-centered models of care that emphasize mutual participation, empathy, and effective communication to improve their HIV health outcomes," Ekpereka Sandra Nawfal, MBBS, MPH, a PhD candidate in the department of epidemiology at Florida International University and lead author of the study, said in a statement to The American Journal of Managed Care®.

References

1. Nawfal ES, Gray A, Ladner R, et al. Race- and ethnicity-specific patient-provider relationship characteristics associated with antiretroviral therpay adherence and viral suppression among minority women with HIV, Miami-Dade County, Florida, 2021-2022. AIDS Care. Published online August 25, 2025. doi:10.1080/09540121.2025.2547943

2. Fast facts: HIV in the US by race and ethnicity. CDC. May 21, 2024. Accessed August 26, 2025. https://www.cdc.gov/hiv/data-research/facts-stats/race-ethnicity.html