# Multi-level Social and Behavioral Determinants of Health and Missed HIV Healthcare Provider Visits

> **NIH NIH R01** · VANDERBILT UNIVERSITY MEDICAL CENTER · 2020 · $388,719

## Abstract

Project Summary/Abstract
 Despite the benefits of engagement in HIV care, a substantial number of black people living with
HIV/AIDS (PLWHA) are poorly retained in care in the United States. An individual's race cannot fully explain
these observed disparities in retention in HIV care. Social and behavioral determinants of health including an
individual's actions, social/physical environment, and access to health services are also modifiable
contributors. However, studies on the combined impact of individual-, community-, infrastructure/health
system-, and structural-level social and behavioral determinants of health on retention in HIV care, with specific
attention to race, are lacking. The aims of this study are: 1) To develop and validate a predictive model which
will include race as well as social and behavioral determinants of heath from multiple levels (individual-,
community-, infrastructure/health system-, and structural-level) and; 2) To identify modifiable individual-level
patient-reported outcomes (i.e. mental health, alcohol and substance use, quality of life, symptom burden)
which partially or fully mediate the relationship between black race and missed visits, after accounting for less
easily modifiable, community-and structural-level confounders. These results will inform the design of an
intervention package aimed to reduce missed HIV healthcare provider visits for black patients, a population
disproportionately affected by poor HIV health-related outcomes. Additionally, they will provide a predictive
model that will allow point-of-care ascertainment of risk of missing visits in order to target this intervention
package toward black patients most likely to benefit.
 This research team is uniquely positioned to complete the work proposed in this application. The
principal investigator, Dr. Pettit has significant experience in conducting epidemiologic studies of HIV outcomes
in large multi-cohort collaborations. Dr. Mugavero, a co-investigator on this proposal, brings content expertise
in retention in HIV care and experience conducting studies of HIV outcomes within the CFAR Network of
Integrated Clinical Systems (CNICS). Drs. Shepherd, Rebeiro, and Turan, also co-investigators on this
proposal, bring complimentary skills in biostatistics and epidemiology as well as behavioral science and
psychometrics required to carry out the analytic plan. Other resources available to the research team include
Vanderbilt's Clinical and Translational Science Award, the Tennessee and University of Alabama Centers for
AIDS Research, and the CFAR Network of Integrated Clinical Systems (CNICS) Core services.
 The proposed studies will provide important insights into the contribution of factors from multiple levels
on missed HIV healthcare provider visits among black PLWHA in the United States. Moreover, these findings
will inform the design and evaluation of a future intervention or support package aimed at modifiable social and
behavioral determinants ...

## Key facts

- **NIH application ID:** 9822988
- **Project number:** 5R01MH113438-03
- **Recipient organization:** VANDERBILT UNIVERSITY MEDICAL CENTER
- **Principal Investigator:** APRIL PETTIT
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $388,719
- **Award type:** 5
- **Project period:** 2018-01-01 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9822988

## Citation

> US National Institutes of Health, RePORTER application 9822988, Multi-level Social and Behavioral Determinants of Health and Missed HIV Healthcare Provider Visits (5R01MH113438-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9822988. Licensed CC0.

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