Challenge of meeting the needs of women color enrolling in HIV care: The role of shifting barriers over time

Background and Methods: HIV+ women of color who are new or at risk of falling out of care? have been enrolled prospectively in medical care at 4 sites in Brooklyn using peer outreach worker-case manager pairs since November, 2010 as part of a larger national demonstration project to retain women in care. We report on the first 2 years' participants in Brooklyn and address barriers to care in comparing new vs. at risk women. We hypothesized that women retained in care would report fewer barriers (possible range 0-30) at enrollment and have more health concerns (14 item CDC-HRQOL) than those who dropped out. We also hypothesized that barriers to care would change over time. Findings: 151 women enrolled, 63 (41.7%) new and 88 (58.3%) at risk of dropping out of care. Mean age was 38.2 (±12.8). 80% were of African descent, 76% US born, 74% were single, 49% high school or higher education,18% employed/school, 95% public insurance, and 26% unstable housing. 70 of the 109 who had been in care for 12+ months for 12 were interviewed, and 39 dropped out. From baseline data, no statistical differences in sociodemographic variables, barriers to care, and CDC HR-QOL distinguished retained vs. drop-outs. Among those in care at 12 months, changes in reported barriers and signifcantly better global self-assessed health were found. Conclusions: Since reported barriers shifted over time, psychosocial care plans should reflect these changes to retain vulnerable populations in HIV care.