{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T19:50:32Z","timestamp":1785268232614,"version":"3.55.0"},"reference-count":72,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T00:00:00Z","timestamp":1670457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K01\u2010MH118939"],"award-info":[{"award-number":["K01\u2010MH118939"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>Most people living with HIV (PLH) in the United States are over age 50 and this sector of PLH continues to grow. Aging with HIV can be challenging due to comorbid medical conditions, mental health disorders, substance use, and lack of social and practical support. Additional challenges are faced by older PLH living in the rural United States, such as longer distances to health care, concerns over privacy and stigma, and social isolation. PLH in rural areas have higher mortality rates than urban PLH. We aimed to understand factors associated with HIV care engagement and quality of life in rural US adults over age 50.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cross\u2010sectional study to evaluate the association between patient\u2010level factors and a combined outcome variable encompassing multiple aspects of care engagement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Either online or on paper, 446 participants completed our survey. One\u2010third of the participants (33%) were from the southern United States; one\u2010third were women; one\u2010third were non\u2010White; and 24% completed the survey on paper. In multiple regression analysis, lower income, residing in the southern United States, lacking internet access at home, not having an HIV specialist provider, higher levels of stress, living alone, and longer distance to an HIV provider were all associated with lower engagement in HIV care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings demonstrated multiple potential options for interventions that could improve care engagement, such as providing and enhancing access to technology for health care engagement and remotely delivering social support and mental health services. Research on such potential interventions is needed for older, rural PLH.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jrh.12732","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T04:39:37Z","timestamp":1670560777000},"page":"477-487","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Factors associated with lack of care engagement among older, rural\u2010dwelling adults living with HIV in the United States"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3324-1452","authenticated-orcid":false,"given":"Andrew E.","family":"Petroll","sequence":"first","affiliation":[{"name":"Health Intervention Sciences Group\/Center for AIDS Intervention Research (CAIR) Medical College of Wisconsin  Milwaukee Wisconsin USA"},{"name":"Division of Infectious Diseases Department of Medicine Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine G.","family":"Quinn","sequence":"additional","affiliation":[{"name":"Health Intervention Sciences Group\/Center for AIDS Intervention Research (CAIR) Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"John","sequence":"additional","affiliation":[{"name":"Health Intervention Sciences Group\/Center for AIDS Intervention Research (CAIR) Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zack","family":"Nigogosyan","sequence":"additional","affiliation":[{"name":"Mallinckrodt Institute of Radiology Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7013-9767","authenticated-orcid":false,"given":"Jennifer L.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Health Intervention Sciences Group\/Center for AIDS Intervention Research (CAIR) Medical College of Wisconsin  Milwaukee Wisconsin USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Centers for Disease Control and Prevention.HIV Surveillance Report 2019.CDC;2021."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(17)30066-8"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1086\/590150"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/13591053030086007"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2014.02.704"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1071\/SH11017"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.3851\/IMP2450"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir626"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2012.0329"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3018(14)70018-9"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0B013E31822D490A"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-012-0212-3"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000001511"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120701660338"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1089\/apc.2006.0043"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31802f1318"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.26.1.40"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200418001-00004"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0164027500223004"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/13607860412331336850"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/hsw\/31.4.299"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181ef60c2"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2006.0206"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq243"},{"key":"e_1_2_8_26_1","unstructured":"Centers for Disease Control and Prevention.Diagnoses of HIV Infection among Adults and Adolescents in Metropolitan Statistical Areas\u2014United States and Puerto Rico 2016. 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