Table 3.
Associations between demographic, socioeconomic and clinical characteristics and unmet need for patient navigation services among people with HIV, United States, Medical Monitoring Project, 2015–2017
| Unmet subjective need for patient navigation* | Unmet objective need for patient navigation** | Unmet subjective or objective need for patient navigation | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | %*** (95% CI#) | p-value | APR# (95% CI) | p-value | n | % (95% CI) | p-value | APR (95% CI) | p-value | n | % (95% CI) | p-value | APR (95% CI) | p-value | |
| TOTAL (Row%) [out of 7692] | 625 | 6.1 (5.3–6.9) | 2950 | 28.2 (26.9–29.5) | 3575 | 34.4 (32.9–35.9) | |||||||||
| Demographics | |||||||||||||||
| Age at the time of interview (years) | 0.061 | 0.577 | <.0001 | <0.001 | <.0001 | <0.001 | |||||||||
| 18–24 | 12 | 9.8 (4.3–15.2) | 1.49 (0.82–2.70) | 108 | 43.0 (34.7–51.2) | 1.60 (1.25–2.06) | 120 | 52.7 (45.0–60.3) | 1.55 (1.28–1.88) | ||||||
| 25–34 | 90 | 7.4 (5.1–9.7) | 1.17 (0.83–1.66) | 515 | 35.0 (31.8–38.1) | 1.38 (1.22–1.55) | 605 | 42.4 (38.8–45.9) | 1.31 (1.18–1.46) | ||||||
| 35–44 | 122 | 6.5 (5.1–7.9) | 1.03 (0.77–1.37) | 638 | 32.5 (29.6–35.4) | 1.31 (1.17–1.46) | 760 | 39.0 (36.3–41.7) | 1.23 (1.13–1.35) | ||||||
| 45–54 | 212 | 6.2 (5.0–7.4) | 1.12 (0.89–1.41) | 906 | 26.1 (24.3–27.8) | 1.08 (0.97–1.20) | 1118 | 32.3 (30.2–34.4) | 1.07 (0.98–1.17) | ||||||
| >=55 | 189 | 4.9 (3.6–6.2) | Reference | 783 | 23.8 (21.8–25.7) | Reference | 972 | 28.7 (26.5–30.9) | Reference | ||||||
| Gender | 0.006 | 0.001 | 0.836 | 0.801 | 0.166 | 0.061 | |||||||||
| Male | 422 | 5.8 (4.9–6.7) | Reference | 2096 | 28.1 (26.6–29.6) | Reference | 2518 | 33.9 (32.2–35.5) | Reference | ||||||
| Female | 196 | 7.4 (6.2–8.6) | 1.29 (1.06–1.56) | 810 | 28.7 (26.9–30.5) | 0.99 (0.91–1.07) | 1006 | 36.2 (34.0–38.3) | 1.04 (0.97–1.12) | ||||||
| Transgender | 7 | 2.8 (0.1–5.6)+^ | 0.36 (0.15–0.85) | 42 | 29.1 (20.7–37.6) | 0.91 (0.68–1.22) | 49 | 32.0 (22.8–41.1) | 0.79 (0.60–1.04) | ||||||
| Race/Ethnicity | 0.002 | 0.027 | <.0001 | 0.002 | <.0001 | <0.001 | |||||||||
| White, non-Hispanic | 139 | 4.5 (3.4–5.6) | Reference | 729 | 24.6 (21.9–27.4) | Reference | 868 | 29.2 (26.4–32.0) | Reference | ||||||
| Black, non-Hispanic | 222 | 5.4 (4.5–6.4) | 1.01 (0.77–1.32) | 1450 | 33.0 (31.3–34.8) | 1.30 (1.15–1.48) | 1672 | 38.5 (36.8–40.2) | 1.25 (1.12–1.39) | ||||||
| Hispanic/Latino | 201 | 8.5 (5.2–11.7) | 1.69 (1.07–2.66) | 582 | 24.6 (22.0–27.1) | 1.04 (0.89–1.22) | 783 | 33.1 (30.1–36.0) | 1.15 (1.03–1.29) | ||||||
| Other | 63 | 9.2 (6.6–11.9) | 1.67 (1.07–2.61) | 189 | 27.1 (22.3–32.0) | 1.05 (0.88–1.26) | 252 | 36.3 (31.0–41.6) | 1.15 (0.99–1.34) | ||||||
| Foreign born | 0.028 | --- | --- | <.0001 | --- | <.0001 | --- | ||||||||
| No | 545 | 6.3 (5.4–7.2) | --- | 2602 | 29.2 (27.8–30.6) | --- | 3147 | 35.5 (34.0–37.1) | --- | ||||||
| Yes | 74 | 4.7 (3.5–5.9) | --- | 336 | 22.3 (19.9–24.8) | --- | 410 | 27.0 (24.4–29.6) | --- | ||||||
| English proficiency | 0.817 | --- | --- | <.0001 | 0.014 | 0.002 | <0001 | ||||||||
| Not proficient | 165 | 6.4 (3.0–9.9) | --- | 538 | 23.0 (20.4–25.6) | 0.87 (0.77–0.97) | 703 | 29.5 (26.0–32.9) | 0.89 (0.80–0.99) | ||||||
| Proficient | 459 | 6.0 (5.3–6.7) | --- | 2412 | 29.5 (28.0–31.0) | Reference | 2871 | 35.6 (34.0–37.2) | Reference | ||||||
| Health literacy | <.0001 | 0.005 | 0.041 | --- | 0.155 | --- | |||||||||
| Limited health literacy | 227 | 9.7 (7.7–11.6) | 1.43 (1.11–1.84) | 614 | 26.1 (23.6–28.6) | --- | 841 | 35.8 (33.0–38.7) | --- | ||||||
| Adequate health literacy | 395 | 5.0 (4.3–5.8) | Reference | 2330 | 28.8 (27.5–30.2) | --- | 2725 | 33.9 (32.4–35.4) | --- | ||||||
| Socioeconomic | |||||||||||||||
| Education | 0.070 | --- | --- | 0.131 | --- | 0.157 | --- | ||||||||
| Less than High school, no diploma | 134 | 7.4 (6.0–8.8) | --- | 525 | 26.5 (24.2–28.8) | --- | 659 | 34.0 (31.4–36.6) | --- | ||||||
| High school diploma or GED | 160 | 6.6 (4.9–8.3) | --- | 811 | 29.6 (27.3–32.0) | --- | 971 | 36.2 (33.5–38.9) | --- | ||||||
| More than high school | 331 | 5.5 (4.5–6.4) | --- | 1610 | 28.1 (26.6–29.6) | --- | 1941 | 33.6 (31.9–35.4) | --- | ||||||
| Household income | <.0001 | --- | --- | 0.809 | --- | 0.190 | --- | ||||||||
| 0 – 19,999 | 388 | 7.6 (6.3–8.9) | --- | 1530 | 27.5 (26.0–29.0) | --- | 1918 | 35.1 (33.4–36.9) | --- | ||||||
| 20,000 – 39,999 | 128 | 6.0 (4.6–7.3) | --- | 571 | 27.5 (24.6–30.4) | --- | 699 | 33.5 (30.3–36.6) | --- | ||||||
| 40,000 – 74,999 | 42 | 3.3 (1.9–4.7) | --- | 369 | 28.4 (24.7–32.1) | --- | 411 | 31.7 (27.8–35.6) | --- | ||||||
| >= 75,000 | 29 | 2.3 (1.3–3.3) | --- | 262 | 29.4 (25.9–32.8) | --- | 291 | 31.7 (28.2–35.2) | --- | ||||||
| Poverty | <.0001 | --- | --- | 0.402 | --- | 0.002 | --- | ||||||||
| Above poverty level | 265 | 4.7 (3.9–5.6) | --- | 1437 | 27.3 (25.3–29.3) | --- | 1702 | 32.1 (30.0–34.1) | --- | ||||||
| At or below poverty level | 322 | 7.8 (6.5–9.2) | --- | 1295 | 28.5 (26.7–30.3) | --- | 1617 | 36.4 (34.5–38.3) | --- | ||||||
| Homelessness | <.0001 | 0.006 | 0.002 | --- | <.0001 | 0.001 | |||||||||
| No | 515 | 5.5 (4.7–6.4) | Reference | 2617 | 27.7 (26.4–29.1) | 3132 | 33.3 (31.7–34.8) | Reference | |||||||
| Yes | 110 | 12.4 (9.0–15.7) | 1.59 (1.14–2.21) | 332 | 33.5 (29.8–37.2) | 442 | 45.9 (41.5–50.3) | 1.18 (1.07–1.30) | |||||||
| Incarceration history | 0.004 | --- | <.0001 | 0.007 | <.0001 | 0.004 | |||||||||
| No | 576 | 5.9 (5.0–6.8) | --- | 2727 | 27.7 (26.3–29.0) | Reference | 3303 | 33.6 (32.0–35.1) | Reference | ||||||
| Yes | 48 | 9.7 (6.8–12.7) | --- | 221 | 38.4 (33.8–43.0) | 1.22 (1.06–1.40) | 269 | 48.2 (43.0–53.4) | 1.21 (1.07–1.36) | ||||||
| Health insurance or coverage | <.0001 | <0.001 | <.0001 | 0.005 | <.0001 | <0.001 | |||||||||
| Private insurance | 158 | 4.3 (3.2–5.5) | 0.24 (0.15–0.37) | 961 | 27.9 (25.5–30.3) | 0.66 (0.51–0.84) | 1119 | 32.3 (29.7–34.8) | 0.49 (0.42–0.57) | ||||||
| Public insurance (excluding RW/ADAP# only) | 395 | 6.4 (5.4–7.5) | 0.26 (0.18–0.36) | 1701 | 28.3 (26.7–29.9) | 0.66 (0.51–0.84) | 2096 | 34.8 (33.0–36.5) | 0.49 (0.42–0.57) | ||||||
| RW/ADAP Only | 39 | 6.1 (3.8–8.5) | 0.24 (0.14–0.42) | 209 | 25.3 (21.6–29.0) | 0.55 (0.40–0.74) | 248 | 31.5 (27.9–35.2) | 0.42 (0.34–0.50) | ||||||
| No insurance coverage | 26 | 25.7 (16.2–35.2) | Reference | 52 | 49.1 (38.0–60.3) | Reference | 78 | 74.7 (65.2–84.3) | Reference | ||||||
| Risk behavior | |||||||||||||||
| Binge drinker | 0.084 | --- | 0.306 | --- | 0.059 | --- | |||||||||
| No | 523 | 5.9 (5.0–6.8) | --- | 2446 | 28.0 (26.6–29.3) | --- | 2969 | 33.9 (32.3–35.4) | --- | ||||||
| Yes | 100 | 7.4 (5.7–9.1) | --- | 484 | 29.4 (26.7–32.2) | --- | 584 | 36.8 (33.7–40.0) | --- | ||||||
| Alcohol use before or during sex | 0.230 | --- | 0.371 | --- | 0.171 | --- | |||||||||
| No | 202 | 5.7 (4.5–7.0) | --- | 1049 | 28.0 (25.7–30.3) | --- | 1251 | 33.8 (31.3–36.3) | --- | ||||||
| Yes | 147 | 6.7 (5.4–8.0) | --- | 717 | 29.4 (26.9–31.9) | --- | 864 | 36.1 (33.4–38.8) | --- | ||||||
| Non-injection drug use | 0.002 | 0.001 | <.0001 | 0.001 | <.0001 | <0.001 | |||||||||
| No | 389 | 5.2 (4.1–6.3) | Reference | 1934 | 26.5 (25.1–27.9) | Reference | 2323 | 31.7 (30.0–33.4) | Reference | ||||||
| Yes | 234 | 8.4 (6.8–9.9) | 1.48 (1.17–1.86) | 1006 | 32.1 (29.9–34.4) | 1.15 (1.06–1.25) | 1240 | 40.5 (37.9–43.2) | 1.20 (1.13–1.29) | ||||||
| Non-injection drug use before or during sex | 0.000 | --- | 0.000 | --- | <.0001 | --- | |||||||||
| No | 213 | 5.0 (3.9–6.1) | --- | 1216 | 27.1 (25.0–29.2) | --- | 1429 | 32.1 (29.8–34.3) | --- | ||||||
| Yes | 133 | 9.0 (6.9–11.1) | --- | 556 | 32.8 (30.0–35.6) | --- | 689 | 41.8 (38.7–44.9) | --- | ||||||
| Sexual risk behavior | 0.485 | --- | 0.408 | --- | 0.660 | --- | |||||||||
| No | 276 | 6.4 (5.3–7.5) | --- | 1150 | 27.6 (25.8–29.4) | --- | 1426 | 34.0 (32.0–36.0) | --- | ||||||
| Yes | 341 | 5.9 (4.9–6.9) | --- | 1748 | 28.6 (26.7–30.5) | --- | 2089 | 34.6 (32.6–36.6) | --- | ||||||
| Same/opposite gender sexual behavior/orientation | 0.034 | --- | 0.389 | --- | 0.126 | --- | |||||||||
| MSM | 269 | 5.7 (4.7–6.7) | --- | 1363 | 27.3 (25.6–29.1) | --- | 1632 | 33.0 (31.3–34.8) | --- | ||||||
| MSW only | 142 | 5.9 (4.6–7.1) | --- | 694 | 29.5 (26.9–32.0) | --- | 836 | 35.4 (32.6–38.2) | --- | ||||||
| WSM | 190 | 7.4 (6.2–8.7) | --- | 790 | 28.7 (26.8–30.6) | --- | 980 | 36.2 (33.9–38.5) | --- | ||||||
| Others | 24 | 5.0 (2.7–7.3) | --- | 103 | 29.5 (23.6–35.3) | --- | 127 | 34.5 (28.0–40.9) | --- | ||||||
| Clinical | |||||||||||||||
| Depression | <.0001 | <0.001 | 0.494 | --- | <.0001 | <0.001 | |||||||||
| No depression | 352 | 4.3 (3.5–5.2) | Reference | 2284 | 28.1 (26.5–29.7) | --- | 2636 | 32.4 (30.8–34.1) | Reference | ||||||
| Other depression | 99 | 8.8 (6.3–11.2) | 1.67 (1.29–2.16) | 316 | 27.6 (24.2–30.9) | --- | 415 | 36.4 (33.0–39.8) | 1.05 (0.96–1.16) | ||||||
| Major depression | 166 | 16.1 (13.3–18.9) | 2.95 (2.18–3.99) | 333 | 30.2 (26.8–33.6) | --- | 499 | 46.4 (42.7–50.1) | 1.35 (1.23–1.48) | ||||||
| Recently diagnosed with HIV (<1 year) | 0.329 | --- | 0.003 | --- | <.0001 | 0.014 | |||||||||
| No | 621 | 6.1 (5.2–6.9) | --- | 2909 | 28.1 (26.8–29.4) | --- | 3530 | 34.2 (32.7–35.7) | Reference | ||||||
| Yes | 4 | 10.6 (0.0–22.4)+^ | --- | 41 | 46.1 (33.2–59.0) | --- | 45 | 56.7 (45.4–68.1) | 1.39 (1.10–1.76) | ||||||
| Ryan White HIV/AIDS program-funded facility | 0.047 | --- | 0.984 | --- | 0.379 | --- | |||||||||
| No | 146 | 4.6 (3.7–5.6) | --- | 725 | 25.6 (22.7–28.6) | --- | 871 | 30.3 (27.1–33.5) | --- | ||||||
| Yes | 430 | 6.3 (5.1–7.4) | --- | 1855 | 25.7 (24.5–26.9) | --- | 2285 | 32.0 (30.4–33.5) | --- | ||||||
*
Unmet subjective need for patient navigation was defined as not getting patient navigation service despite reporting need for the service in the past 12 months, irrespective of viral load status (suppressed or unsuppressed).
**
Unmet objective need for patient navigation was defined as not getting patient navigation, not reporting need for the service, but did not have sustained viral suppression over the past 12 months
***
Percentages are weighted percentages.
#
CI = Confidence Interval; APR = Adjusted Prevalence Ratio; RW = Ryan White HIV/AIDS Program; ADAP = AIDS Drug Assistance Program
+
Coefficient of Variation (CV)>=0.30, indicating that the estimate is not reliable with high variance.
^
Values with a denominator sample size <30, values with an absolute CI width of between 0.05 and 0.30, and a relative CI width 130% are marked with # and should be interpreted with caution