3 - (SYM 106) Untangling Threads: A Longitudinal Examination of Trauma Exposure and Posttraumatic Distress in a Public HIV Care Clinic

Background: Persons living with HIV (PLWH) are disproportionately exposed to traumatic events. Trauma contributes to well-documented HIV health consequences, including lower adherence to antiretroviral medications, higher viral load, and lower CD4 count. However, the existing literature has poorly distinguished between the effects of trauma exposure and posttraumatic psychological distress on HIV-related behavioral and biomedical outcomes over time, and studies from real-world HIV treatment settings are particularly lacking. We leveraged data from a primary HIV care clinic to examine the longitudinal effects of trauma exposure and posttraumatic psychological distress on HIV health outcomes.

Method: PLWH (N = 245) in a public HIV health clinic in South Florida completed a baseline and one-year follow-up assessment. Baseline measures included the Brief Trauma Questionnaire, Patient Health Questionnaire, Anxiety Thermometer, and Primary Care PTSD Screen for DSM. At follow-up, participants rated their HIV medication adherence over the past month on a 6-point scale. Log HIV RNA viral load and CD4 count within 3 months of the follow-up were extracted from medical records. We utilized path analysis to examine the direct and indirect effects of lifetime trauma exposure and baseline psychological distress (indicated by depression, anxiety, and posttraumatic stress symptoms) on follow-up adherence and HIV RNA log viral load and CD4 count.

Results: Participants were 51 years old on average (SD = 11), and 76% were Black. Participants endorsed 2.6 of the 10 assessed lifetime traumas on average, and 87.8% reported at least one prior trauma. Lifetime trauma exposure was associated with higher psychological distress at baseline (est. = .506, p = .012). Baseline psychological distress predicted poorer HIV medication adherence at follow-up (est. = -.042, p = .013), controlling for trauma exposure. Medication adherence at follow-up was associated with lower log viral load (est. = -.497, p < .001) and higher CD4 count (est. = 78.532, p =.001), controlling for trauma exposure and psychological distress.

Conclusion: Findings indicate high community prevalence of trauma exposure among PLWH in public HIV care. Psychological distress but not trauma exposure decreased HIV medication adherence over time. Embedding assessments and interventions for psychological distress in HIV care settings may help to improve behavioral and downstream biomedical outcomes among PLWH with trauma histories.