Self-rated health and HIV outcomes among adults with diagnosed HIV — Medical Monitoring Project, United States

Abstract

Objective(s): To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection. Design: We analyzed interview and medical record data collected during June 2020–May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into “good or better” and “poor or fair”. We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics. Results: Nationally, 72% of PWH reported “good or better” SRH. PWH with the following characteristics had a lower prevalence of “good or better” SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI: 0.81–0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI: 0.43–0.59) and anxiety (aPR 0.60, 95% CI: 0.54–0.68), unstable housing or homelessness (aPR 0.77, 95% CI: 0.71–0.82), and hunger or food insecurity (aPR 0.74, 95% CI: 0.69–0.80), as well as having a mean CD4 count <200 cells/mm3 vs. CD4+ >500 cells/mm3 (aPR 0.70, 95% CI: 0.57–0.86). Conclusions: Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the United States. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH.