Table 3.
Results from Parallel Mediation Analysis Predicting Electronically Monitored (MEMS) Adherence and HIV Care Engagement with Perceived Discrimination and Medical Mistrust.
| Variables | Specific and total indirect effects, direct effects, and total effects |
Estimate | S.E. | 95% bootstrap CI |
|---|---|---|---|---|
| 1-month MEMS ART adherence (continuous outcome) | ||||
| Perceived discrimination due to HIV-serostatus | Specific indirect effects through mistrust towards healthcare organizations | −0.002 | 0.002 | −0.007, 0.002 |
| Specific indirect effects through mistrust towards one's physician | −0.002 | 0.002 | −0.006, 0.002 | |
| Specific indirect effects through HIV-related mistrust beliefs | −0.002 | 0.002 | −0.007, 0.001 | |
| Total indirect effects | −0.006 | 0.002 | −0.012, −0.002 | |
| Direct effects | −0.017 | 0.009 | −0.033, 0.002 | |
| Total effects | −0.023 | 0.008 | −0.038, −0.007 | |
| Perceived discrimination due to race (Black) | Specific indirect effects through mistrust towards healthcare organization | −0.002 | 0.002 | −0.007, 0.002 |
| Specific indirect effects through mistrust towards one's physician | −0.001 | 0.002 | −0.005, 0.002 | |
| Specific indirect effects through HIV-specific mistrust beliefs | −0.003 | 0.002 | −0.006, 0.000 | |
| Total indirect effects | −0.006 | 0.003 | −0.012, −0.002 | |
| Direct effects | −0.009 | 0.007 | −0.022, 0.005 | |
| Total effects | −0.016 | 0.006 | −0.028, −0.003 | |
| Perceived discrimination due to sexual orientation | Specific indirect effects through mistrust towards healthcare organization | −0.001 | 0.001 | −0.004, 0.001 |
| Specific indirect effects through mistrust towards one's physician | −0.001 | 0.002 | −0.005, 0.002 | |
| HIV-related mistrust beliefs | −0.002 | 0.001 | −0.005, 0.000 | |
| Total indirect effects | −0.004 | 0.002 | −0.008, 0.000 | |
| Direct effects | −0.015 | 0.007 | −0.028, −0.001 | |
| Total effects | −0.019 | 0.007 | −0.032, −0.004 | |
| Care engagement (binary outcome) | ||||
| Perceived discrimination due to HIV-serostatus | Specific indirect effects through mistrust towards healthcare organization | 0.018 | 0.017 | −0.010, 0.062 |
| Specific indirect effects through mistrust towards one's physician | −0.047 | 0.022 | −0.110, −0.015 | |
| Specific indirect effects through HIV-related mistrust beliefs | −0.030 | 0.018 | −0.074, −0.002 | |
| Total indirect effects | −0.060 | 0.026 | −0.116, −0.014 | |
| Direct effects | −0.087 | 0.060 | −0.212, 0.023 | |
| Total effects | −0.147 | 0.058 | −0.271, −0.041 | |
| Perceived discrimination due to race (Black) | Specific indirect effects through mistrust towards healthcare organization | 0.019 | 0.019 | −0.016, 0.059 |
| Specific indirect effects through mistrust towards one's physician | −0.047 | 0.020 | −0.094, −0.014 | |
| Specific indirect effects through HIV-related mistrust beliefs | −0.025 | 0.016 | −0.060, 0.004 | |
| Total indirect effects | −0.053 | 0.026 | −0.108, −0.006 | |
| Direct effects | −0.047 | 0.058 | −0.156, 0.074 | |
| Total effects | −0.099 | 0.051 | −0.196, 0.005 | |
| Perceived discrimination due to sexual orientation | Specific indirect effects through mistrust towards healthcare organization | 0.004 | 0.008 | −0.008, 0.027 |
| Specific indirect effects through mistrust towards one's physician | −0.043 | 0.020 | −0.092, −0.012 | |
| Specific indirect effects through HIV-related mistrust beliefs | −0.013 | 0.011 | −0.046, 0.000 | |
| Total indirect effects | −0.052 | 0.021 | −0.101, −0.018 | |
| Direct effects | −0.074 | 0.055 | −0.179, 0.040 | |
| Total effects | −0.126 | 0.054 | −0.230, −0.019 |
Note. Significant specific and total indirect effects, direct effects, and total effects are presented in bold. MEMS = medication event monitoring system. Parallel mediators include: 1) mistrust towards healthcare organization, 2) mistrust towards physicians, and 3) HIV-related mistrust beliefs. 95% bootstrap CI = 95% bootstrap confidence interval (10,000 replications).