Adults with LEP were more likely than EP adults to receive care at RWHAP-funded facilities (79.0% vs 67.0%)

Description #

A higher percentage of adults with LEP than adults with EP received care at Ryan White HIV/AIDS Program (RWHAP)-funded facilities (79.0% vs. 67.0%) (Table 1). The authors offer this differential attendance as the leading mechanistic explanation for the better clinical outcomes seen among adults with LEP, because RWHAP-funded facilities are far more likely to provide support services — including interpreter and social services — to marginalized populations.

"Higher percentages of adults with LEP, compared with adults with EP, received care at RWHAP-funded facilities (79.0% vs. 67.0%)" (Padilla, 2021)

"A possible explanation for this seeming paradox is that a higher percentage of adults with LEP than adults with EP received care at RWHAP-funded facilities, which are twice as likely as other facilities to provide support services – including interpreter and social services – necessary for marginalized populations to achieve successful outcomes (Weiser et al., 2015)." (Padilla, 2021)

Methods Context #

What? #ⓘ

The observable: whether a participant's primary HIV care facility received any RWHAP funding, expressed as a weighted percentage and compared between LEP and EP groups.

"We ascertained whether participants' primary HIV care facility received any Ryan White HIV/AIDS Program (RWHAP) funding." (Padilla, 2021)

How? #ⓘ

Facility RWHAP-funding status was ascertained per participant; weighted percentages with 95% CIs were computed and compared between LEP and EP groups using modified Rao-Scott chi-square tests (P < .05 significant) in SAS 9.3.

"We used modified Rao-Scott chi-square tests to assess sociodemographic, behavioral, and clinical differences between adults with LEP and EP (P < .05 considered significant)." (Padilla, 2021)

Who? #ⓘ

Nationally representative sample of adults aged ≥18 with diagnosed HIV living in US states (N = 11,371; LEP n = 1,090), from the Medical Monitoring Project two-stage probability survey, June 2015–May 2018.

"The Medical Monitoring Project (MMP) is an annual cross-sectional survey designed to produce nationally representative estimates of the behavioral and clinical characteristics of adults with diagnosed HIV in the United States." (Padilla, 2021)

Other Notes #

The authors explicitly note they "did not measure access to language services among persons with LEP," so the interpreter-services component of this mechanism is inferred from facility type rather than directly observed.

Caveats #

• Cross-sectional self-reported data with no measure of language-service access prevents causal inference about the LEP outcome paradox The data are cross-sectional, so causality cannot be inferred from the association between LEP and better clinical outcomes. Critically, the authors did not measure access to language services among persons with LEP, so the proposed mechanism (that interpreter and support services at RWHAP-funded facilities drive the better outcomes) is not directly tested. Behavioral measures, including ART adherence, were self-reported and subject to social-desirability and recall bias. Finally, the analysis only includes adults aware of their HIV diagnosis, and because LEP is a barrier to HIV testing, persons with LEP may be disproportionately undiagnosed and excluded, potentially biasing the sample toward those already engaged in care.