Antiretroviral Medication Adherence Research Articles

Facilitators and Barriers to Adherence to Anti-Retroviral Treatment Among Pregnant or Breastfeeding Women Living with HIV and Perinatally Infected Infants: A Scoping Review.

In 2022, 54% of 1.5million children (age 0-14) living with HIV had access to anti-retroviral medication (ART). Adherence to ART for pregnant or breastfeeding HIV + women is critical for maintaining their personal health and to prevent mother-to-child-transmission (MTCT). For HIV + infants, adherence is essential to establish early viremic control and is contingent on caregiver administration. We conducted a scoping review to systematically identify and categorize the influences on ART adherence for pregnant or breastfeeding HIV + women and their HIV + infants. We searched databases in June 2023 and employed the Social-Ecological Model (SEM) to organize facilitators and barriers to adherence referenced in published articles. All articles published before 2016 were excluded due to updated guidelines from WHO on MTCT and ART. Our analysis included 52 articles. 50/52 took place in Africa and used cross-sectional and mixed-methods design. Barriers to adherence for pregnant or breastfeeding HIV + women included maternal education, self-efficacy, social support, and social/economic context. Barriers to infant adherence included development, nutrition, age of treatment initiation, disclosure, and ART side effects. Additional facilitators and barriers to adherence are presented at family, extra-familial, and socio-cultural SEM levels. Stigma was the most salient barrier referenced across the entire continuum of HIV care and all SEM levels. This review revealed a dearth of literature focusing on HIV + infants who are dependent on their caregivers for ART adherence and lack of a standard adherence measure. We identified multi-leveled influences on adherence impacting both the mother and infant and are amenable to public health intervention.

Antiretroviral medication adherence among patients with HIV

Antiretroviral medication adherence among patients with HIV

Relationship Between Patient Portal Tool Use and Medication Adherence and Viral Load Among Patients Living with HIV

BackgroundPatient portals play an increasingly critical role in engaging patients in their health care. They have the potential to significantly impact the health of those living with chronic diseases, such as HIV, for whom consistent care engagement is both critical and complex.ObjectiveThe primary aim was to examine the longitudinal relationships between individual portal tool use and health-related outcomes in patients living with HIV.DesignRetrospective cohort study using electronic health record data to examine the relationship between patient portal tool use and key HIV-specific, health-related outcomes in patients engaged in care in the Veterans Health Administration (VA) through the application of marginal structural models.ParticipantsA national sample of patients living with HIV (PLWH) active in VA care who were registered to use the VA’s patient portal, My HealtheVet (MHV; n = 18,390) between 10/1/2012 and 4/1/2017.Main MeasuresThe MHV tools examined were prescription refill (including prescription refill of an antiretroviral (ART) medication and any medication), secure messaging, view appointments, and view labs. Primary outcomes were viral load test receipt, viral load suppression, and ART medication adherence (measured as proportion of days covered).Key ResultsThe use of prescription refill for any medication or for ART was positively associated with ART adherence. Secure messaging was positively associated with ART adherence but not with viral load test receipt or viral load suppression. The use of view appointments was positively associated with ART adherence and viral load test receipt but not viral load suppression. The use of view labs was positively associated with viral load suppression but not ART adherence or viral load test receipt.ConclusionsThese findings highlight the valuable role patient portals may play in improving health-related outcomes among PLWH and have implications for patients living with other types of chronic disease.

Unannounced phone-based pill counts for monitoring antiretroviral medication adherence in South Africa

Background Unannounced phone-based pill counts (UPC) are an objective measure of medication adherence that may be used in resource limited settings. The current study reports the feasibility and validity of UPC for monitoring antiretroviral therapy (ART) adherence among people living with HIV in South Africa. People living with HIV (N = 434) in an economically impoverished township and receiving ART for at least 3-months completed: two UPC in a one-month period; measures of clinic and medication experiences; and provided blood samples for HIV viral load and CD4 testing. Analyses compared two methods for managing values of over-dosing (> 100%), specifically censoring values to 100% (> 100% = 100%) vs. subtracting over-dosing from two months of perfect adherence (200% - > 100% value). Results Findings showed that two UPC calls were successfully completed with 91% of participants in a one-month period. The average number of call attempts needed to reach participants was 2.4. Results showed that lower UPC adherence was significantly associated with male gender, alcohol use, higher HIV viral loads, lower CD4 cell counts, running out of ART, and intentionally not taking ART. Comparisons of methods for adjusting over-dosing found subtraction yielding a better representation of the data than censoring. Conclusions UPC were demonstrated feasible and valid with patients receiving ART in a resource limited setting and offers a viable method for objectively measuring ART adherence in these settings.

Implementation of pharmacist-led services for sexual and gender minorities: A multisite descriptive report.

This paper compares and contrasts the implementation of pharmacist-led services for 3 different sexual and gender minority populations across California, Mississippi, and Florida. Implementation of pharmacist-led services tailored to sexual and gender minorities may be a potential mechanism to address health disparities in these populations. Clinical pharmacists have the potential to provide care with cultural humility and improve health outcomes by optimizing medication regimens, reducing adverse drug events, enhancing medication acquisition, and improving medication adherence. The services provided by clinical pharmacists varied across sites and included management of gender-affirming hormone therapy, HIV antiretroviral medication adherence programming, primary care and chronic disease state management, and involvement in care related to mental health, psychiatry, and substance use as well as sexual health. Various legislative and regulatory barriers and differences in scope of practice for pharmacists were also identified. This paper advocates for the expansion of pharmacy-led services and the adoption of a culturally humble approach to patient care.

Does the Quality of Behavior Change Counseling in Routine HIV Care Vary According to Topic and Demand?

HIV clinicians face increasing time constraints. Our objective was to describe the prevalence and quality of behavior change counseling within routine HIV visits and to explore whether clinicians may provide lower quality counseling when facing increased counseling demands. We audio-recorded and transcribed encounters between 205 patients and 12 clinicians at an urban HIV primary care clinic. We identified and coded episodes of behavior change counseling to determine clinicians' consistency with motivational interviewing (MI) and used multi-level regression to evaluate counseling quality changes with each additional topic. Clinician counseling for at least one behavior was indicated in 92% of visits (mean 2.5/visit). Behavioral topics included antiretroviral medication adherence (80%, n = 163), appointment adherence (54%, n = 110), drug use (46%, n = 95), tobacco use (45%, n = 93), unsafe sex (43%, n = 89), weight management (39%, n = 80), and alcohol use (35%, n = 71). Clinician counseling was most MI-consistent when discussing drug and tobacco use and least consistent for medication and appointment adherence, unsafe sex, and alcohol use. In multilevel analyses, clinician counseling was significantly less MI-consistent (β = -0.14, 95% CI -0.29 to -0.001) with each additional behavior change counseling need. This suggests that HIV ambulatory care be restructured to allocate increased time for patients with greater need for behavior change.

Barriers to Antiretroviral Medication Adherence in People Living with HIV (PLHIV) at the Time of the COVID-19 Pandemic in the Philippines.

Background: During the COVID-19 pandemic, the HIV crisis in the Philippines worsened and triggered a chain reaction that disrupted the provision and utilization of HIV services. This study aims to fill in the gap in knowledge by exploring the possible association between sociodemographic characteristics and the barriers to ART adherence for PLHIV in the Philippines at the time of the COVID-19 pandemic. Methods: A cross-sectional study was performed by using a survey questionnaire, which was distributed via online social media (Twitter). Data were analyzed using the Stata software. Results: There is a significant association between the following treatment barriers and sociodemographic characteristics: the location of treatment hubs and respondents who finished college/graduate studies; checkpoints and crossing borders; and (1) respondents from Northern Luzon Region, (2) unemployed respondents and financial assistance-1. respondents 18 to 25 years old; 2. unemployed respondents-(3) respondents who finished elementary/high school and psychosocial support-(1) respondents from the NCR; (2) respondents 26 to 30 years old, stocks of ARVs and other medicines, and employed respondents. Conclusions: The results suggest a necessity for innovative approaches to make HIV care services, particularly ART, more accessible to PLHIV during the COVID-19 pandemic. Future large-scale studies exploring the association between sociodemographic characteristics and barriers to medication adherence of PLHIV during the COVID-19 pandemic are recommended.

Peer Support and Anti-retroviral (ARV) Medication Adherence Among People Living with HIV/AIDS: A Cross-Sectional Study

One of the supports that People Living with HIV/AIDS (PLWHA) can provide each other is the encouragement to take medicine. Medication adherence and not resisting therapy are very important for PLWHA to maintain their immune system, suppress viral replication, and improve quality of life. This study aimed to determine whether there was a relationship between peer support and anti-retroviral (ARV) medication adherence among people living with HIV/AIDS (PLWHA). . The study was conducted in August 2020. The research design used was a correlational study using a cross-sectional approach. The sampling technique used was total sampling. The respondents in this study were PLWHA who are at Cahaya Kasih Peduli AIDS Foundation, WPA Turen n = 45. The variables studied were peer support as the independent variable and medication adherence as the dependent variable. The data collection technique used was a questionnaireThe data analysis method used was the Spearman Rank correlation test using SPSS 25 with a significance of p <0.05. From this study, it was found that 20 (44.4%) for good peer support, 25 (55.6%) for sufficient peer support 13 (28.9%) had high adherence to taking medication, 15 (33.3%) had moderate adherence, and 17 (37.8%) had low adherence. The results of statistical tests in this study showed no significant relationship between peer support and medication adherence to People Living with HIV/AIDS at Cahaya Kasih Peduli AIDS Foundation, WPA Turen, with a significance value of p-value = 0.313. It was found that there is no relation between peer support and medication adherence to PLWHA at the Cahaya Kasih Peduli AIDS Foundation, Turen. Respondents are always expected to pay attention to their medication schedule and be more active in socializing and providing mutual support to fellow PLWHA.
 Keywords: Peer Support, Medication Adherence, People Living with HIV / AIDS (PLWHA)

Antiretroviral medication adherence for people with HIV/AIDS.

People with HIV/AIDS require treatment with antiretrovirals (ARV) to reduce the amount of HIV virus in the body so it does not enter the AIDS stage, while people with AIDS require ARV treatment to prevent opportunistic infections with various complications. This study aimed to determine the ARV medication adherence of people living with HIV/AIDS (PLWHA), get information on the facts that influence PLWHA's use of ARV, analyze factors that influence PLWHA's use of ARV, and get information about treatment management for PLWHA. This study is a systematic review. Research information was obtained using the Google Scholar facility and an index of journal publications. Factors related to ARV adherence in PLWHA include family support, level of knowledge, peer group support, side effects of medicine, motivation, behavioral skills, psychology of PLWHA patients, boredom, stigma, health care facilities, therapy guidelines, characteristics of comorbidities, perception, gender, health insurance, self-efficacy, social isolation, age, education level, income, duration of ARV treatment, support from health workers, spiritual motivation, and use of health services for the last three years. Adherence and family support play important roles in healing PLWHA. PLWHA must adhere to treatment with antiretrovirals. Family support plays an important role in healing PLWHA. It is suggested to the families of PLWHA that they give motivation and comply with the advice of health workers.

Comparative Study of Antiretroviral Medication Adherence Amongst Plwha in Selected Districts of Taraba State, Nigeria

Comparative Study of Antiretroviral Medication Adherence Amongst Plwha in Selected Districts of Taraba State, Nigeria

Adherence to Antiretroviral Therapy (Art) among Pregnant Women Living with HIV/AIDS in Okigwe Imo State, Nigeria

The antiretroviral medication (ART) compliance of expectant HIV/AIDS patients in Nigeria's Okigwe Imo state was investigated in this study. In particular, the study established the prevalence of HIV among expectant mothers in Okigwe Imo State, Nigeria, identified the behavioral and demographic factors associated with ART adherence, and looked at the obstacles to ART use among expectant mothers in Okigwe Imo State, Nigeria. The study adopted the AIDS risk reduction model by Catania and Coates, (1990), the pathway of survival model theory by Mosley and Chen (1984) and the health belief model by Rosenstock et al (1950). From the responses obtained and analysed, the findings revealed that the extent of the prevalence of HIV among pregnant women in Okigwe Imo State, Nigeria is low. Also, the findings revealed that there is a significant relationship between demography and ART adherence among pregnant women in Okigwe Imo State, Nigeria. The findings further revealed that there is a significant relationship between behaviour and ART adherence among pregnant women in Okigwe Imo State, Nigeria. The study therefore recommends that PMTCT services should be accessible to every pregnant woman attending antenatal care, either onsite or through a referral to a nearby clinic, to improve coverage. When it comes to locating PMTCT facilities, using a geographic information system can help eliminate inequity and enhance accessibility within states.

Incidence of Opportunistic Infections among HIV-infected Children on ART at Gondar University Specialized Hospital, Ethiopia

Objective: To assess the prevalence and determinants of opportunistic infections among HIV-infected children receiving antiretroviral medication (ART) at the University of Gondar’s comprehensive specialty hospital. Methods: A retrospective cohort research was undertaken at the University of Gondar comprehensive specialized hospital between January 11, 2017, and January 10, 2022. The study included 389 HIV-positive children on antiretroviral therapy. A data extraction form derived from the ART entry and follow-up forms was used to collect data from the charts of HIV-infected persons. The data was entered using Epi-dataTM Version 4.5, and the data was analyzed using StataTM Version 16. ofBivariate and multivariate semi-parametric and parametric regression models were fitted to identify risk factors of opportunistic infections. The Kaplan Meier survival curve was used to calculate the time gap between opportunistic infections. Result: Between January 11, 2017, and January 10, 2022, 389 HIV-infected children started antiretroviral therapy (ART). The overall Incidence of opportunistic infections was 4.2 (95 percent CI 3.75 to 4.46) per 100 person-year observation during the follow-up period, which lasted a median of 67 months (IQR=58-76 months). The most common OI at follow-up was bacterial pneumonia, which was 13.5 (95 percent CI: 10.29,17.7). Children with baseline CD4 200 cells/l counts (AHR= 2.05 (1.40, 3.00), baseline Hgb level of 10 g/dl (AHR=5.87 (3.97,8.69), ever taking IPT (AHR=1.71(0.94, 3.11), and HIVinfected children with fair/poor ART adherence (AHR=1.41(0.90, 2.19) were all significantly linked to the development of opportunistic infections. Conclusion: In this study, the rate of opportunistic infections among HIV-positive children was quite low. OIs were significantly associated with characteristics such as baseline CD4 count, Hgb level, adherence to ART, and use of IPT. We feel that early screening and treatment of OIs should be explored as a result of dueto the aforesaid findings above. Additionally, adherence assistance through phone calls and case managers might be increased. Furthermore, at each follow-up examination, children with severe immunodeficiency and advanced disease stages at the time of ART initiation should be closely monitored and extensively screened for the occurrence of OIs. Furthermore, at each followup examination, children with severe immunodeficiency and advanced disease stages at the time of ART initiation should be closely monitored and extensively screened for the occurrence of OIs. Additionally, adherence assistance through phone calls and case managers might be increased. Keywords: Children; Antiretroviral therapy; HIV; Opportunistic infections; Ethiopia

Adherence and Counselling on Antiretroviral Regimen: A Cross-sectional Study of Adults’ Living with Human Immunodeficiency Virus at the Korle Bu Teaching Hospital

Objective: Antiretroviral therapy is an effective technique for controlling virus spread and extending the lives of those who are infected. The focus of the research was to look at the link with compliance and counseling in HIV-infected people at the Korle Bu Teaching Hospital in Accra, Ghana.
 Methods: A cross-sectional study was undertaken on 103 HIV-infected people who had been taking ART for more than 6 months at the hospital. The study employed a basic random sampling approach, which provided each participant with an equal opportunity to participate. Statistical Packages for Social Science (SPSS) version 22 was used to evaluate the quantitative data. Descriptive statistics such as frequencies and percentages were used to characterize patients' social-demographic characteristics. To explore about a linkage with adherence and counseling, correlation was used.
 Results: Data of the study was analyzed with SPSS using correlation. Based on the results, the study discovered a substantial linear link between counseling and antiretroviral medication adherence, with a Pearson r correlation of .318 and a significant linear of.001.
 Conclusion: This implies that a counseling session might aid in the understanding of facts provided regarding the infection and medicine, as well as in adhering to the regimen prescribed. In addition, aids in the minimization of the fear of stigmatization.

Life Instability Associated with Lower ART Adherence and Other Poor HIV-Related Care Outcomes in Older Adults with HIV.

Life instability may be an important factor for HIV-related care outcomes in older adults living with HIV (OALWH). This study examined the degree to which an 11-item life instability index (LII) composed of individual- and community-level indicators was associated with HIV-related care outcomes-viral load, antiretroviral (ART) medication adherence, rates of detectable viral load, and HIV care appointment non-adherence among OALWH in the Miami area. Six hundred twenty-three OALWH completed an interviewer-administered assessment (English or Spanish), which was matched with medical record data. Participants reported about six LII indicators each (M = 6.08, SD = 1.44). Greater index scores were associated with worse self-reported ART adherence (b = - 1.14, p = 0.03), lower observed appointment adherence (b = 0.02, p < 0.01), higher viral load (b = 0.09, p = 0.02), and greater odds of viral detection (OR = 1.22, p = 0.01). Regarding health behaviors, life instability was significantly associated with increased illicit substance use among participants and not associated with depression or anxiety. The association of life instability to ART adherence remained significant (although attenuated) when controlling for the significant effects of substance use (b = - 0.40, BSTP [- 0.87, - 0.09]). This present study is the first to examine an additive life instability index and its association with HIV-related behavioral and biomedical health outcomes among a population of OALWH. Greater indicators of life instability among OALWH may lead to poorer HIV-related health outcomes above and beyond the net of the effects of depression, anxiety, and substance use.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

BackgroundMedication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.MethodsA cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.ResultsThe magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9–72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03–5.62)], having social support [AOR = 1.11, (95% CI 1.02–1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93–5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04–1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01–3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.ConclusionsA large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

Challenges Facing Antiretroviral Medication Adherence among People Living With Hiv/Aids. A Case of Dodoma City and Kongwa District in Tanzania

The purpose of this study is to analyze the challenges of adherence to antiretroviral therapy (ART) for people living with HIV/AIDS (PLWHIV/AIDS) in Dodoma City and Kongwa District, Tanzania. Data was gathered through document reviews, interviews, and Focus Group Discussions. For this study, 99 respondents were chosen and interviewed as representatives from four hospitals, two health centres, and one dispensary. The quantitative data was obtained using an interview schedule, while the qualitative data was collected using Focus Group Discussions and key informant interviews, and the quantitative data were analyzed using SPSS version 16 software while qualitative data were analyzed by using content analysis. The study revealed five challenges facing PLWHIV/AIDS including the leading stigmatization followed by taking too many tablets, negligence in taking tablets, side effects and the least was side effects impact of medication. The study recommends the following first families, health care facilities, dispensaries, and hospitals must treat PLWHIV/AIDS patients with dignity and respect. Also, global and local HIV/AIDS development partners, notably pharmaceutical companies, should seek ART dosages that allow PLWHIV/AIDS to take only a few medications.

A Review on Medication Adherence on Antiretroviral Therapy in South East Asia

As of 2018, receiving antiretroviral treatment (ART) was 23.3 million patients with HIV, with 2 million of those people coming from countries in South-East Asian nations, according to the WHO. According to the Center for Disease Dynamics, Economics, and Policy, South East Asia has the world's third-largest HIV pandemic as well as the highest TB burden, accounting for more than a quarter of all HIV infections. Numerous investigations have demonstrated how healthcare professionals may influence patients' medication-taking habits for the better if they persistently and frequently discuss the advantages of ART adherence at each annual checkup, monitor adherence-related clinical markers including viral load, identify adherence hurdles, offer adherence support services, and inform patients of additional therapies that can enhance adherence and lower the risk of problems. Because of varying social ramifications, a wide range of psychological traits, and cultural differences, it is challenging to evaluate Southeast Asians' adherence to antiretroviral medication. The researchers came to the conclusion that self-management, educational intervention, cognitive and adaptive abilities, peer support, and frequent clinic visits are the key characteristics that contribute to medication adherence to antiretroviral drugs in the majority of Southeast Asian nations. Southeast Asian nations suffer from societal consequences including discrimination and stigma, a lack of assistance from the government, and insufficient access to medicine and religion. The desire to continue taking the drug affects adherence to antiretroviral treatment. These claimed causes include forgetfulness, having a full schedule, being strapped for cash, avoiding side effects, and having trouble understanding directions. Given the aforementioned facts, successful management of antiretroviral medication adherence necessitates individual, social, and medical measures.

Psychosocial Interventions to Promote Undetectable HIV Viral Loads: A Systematic Review of Randomized Clinical Trials.

Suppressing HIV viral loads to undetectable levels is essential for ending the HIV/AIDS epidemic. We evaluated randomized controlled trials aimed to increase antiretroviral medication adherence and promote undetectable viral loads among people living with HIV through November 22, 2019. We extracted data from 51 eligible interventions and analyzed the results using random effects models to compare intervention effects between groups within each intervention and across interventions. We also evaluated the relation between publication date and treatment effects. Only five interventions increased undetectable viral loads significantly. As a whole, the analyzed interventions were superior to Standard of Care in promoting undetectable viral loads. Interventions published more recently were not more effective in promoting undetectable viral loads. No treatment category consistently produced significant increases in undetectable viral loads. To end the HIV/AIDS epidemic, we should use interventions that can suppress HIV viral loads to undetectable levels.

Structural Syndemics and Antiretroviral Medication Adherence Among Black Sexual Minority Men Living With HIV.

Background:Although HIV antiretroviral treatment (ART) access and uptake have increased among racial/ethnic minority individuals, lower rates of ART adherence and viral suppression persist, especially among Black men who have sex with men (BMSM) compared with their White counterparts.Setting:Black men who have sex with men living with HIV (BMSM+) residing in Los Angeles County (N = 124) were recruited in-person (eg, clinic) and online (eg, social networking apps).Methods:Participants completed a cross-sectional survey measuring demographic characteristics, structural syndemics (poverty, criminal justice involvement, and housing instability), and psychosocial syndemics (mental health and substance use). A text message survey assessed missed doses of ART over the past week. Zero-inflated Poisson regression models were used to evaluate variables associated with the number of missed doses of ART.Results:On average, participants missed 1.30 doses of ART (SD = 2.09) and reported structural syndemics: poverty (56.1%), criminal justice involvement (36.6%), housing instability (26.3%), and psychosocial syndemics: childhood sexual abuse (51.8%), intimate partner violence (16.9%), depression (39%), and problem alcohol use (15.5%). After controlling for employment, age, education, and psychosocial syndemics, participants with a one-point increase in structural syndemic indicators were found to be 1.63 times more likely to have missed a dose of ART.Conclusions:Structural syndemic were associated with ART nonadherence among BMSM+ after adjusting for demographic and psychosocial factors. HIV treatment interventions that incorporate financial incentives, legal support, and housing may help improve ART adherence among BMSM+. Findings suggest that key priorities to ending the HIV epidemic must include structural interventions that alleviate poverty, eliminate disproportionate policing and criminalization, and end homelessness.

Patient Health Literacy and Communication with Providers Among Women Living with HIV: A Mixed Methods Study.

In this mixed-methods study, we examine the relationship between provider communication and patient health literacy on HIV continuum of care outcomes among women living with HIV in the United States. We thematically coded qualitative data from focus groups and interviews (N = 92) and conducted mediation analyses with quantitative survey data (N = 1455) collected from Women's Interagency HIV Study participants. Four qualitative themes related to provider communication emerged: importance of respect and non-verbal cues; providers' expressions of condescension and judgement; patient health literacy; and unclear, insufficient provider communication resulting in diminished trust. Quantitative mediation analyses suggest that higher health literacy is associated with higher perceived patient-provider interaction quality, which in turn is associated with higher levels of trust in HIV providers, improved antiretroviral medication adherence, and reduced missed clinical visits. Findings indicate that enhancing provider communication and bolstering patient health literacy could have a positive impact on the HIV continuum of care.