Neighborhood community characteristics associated with HIV disease outcomes in a cohort of urban women living with HIV

Abstract

Recent studies have found geographic variations in immune and viral HIV disease outcomes associated with Census measures of neighborhood poverty and segregation. Although readily available, such aggregate Census measures are not based on health behavior models and provide limited information regarding neighborhood effect pathways. In contrast, survey-based measures can capture specific aspects of neighborhood disadvantage that may better inform community-based interventions. Therefore, the aim of this study is to assess the measurement validity of multi-dimensional survey measures of neighborhood disorder compared with Census measures as predictors of HIV outcomes in a cohort of 197 low-income women in a major metropolitan area. The multidimensional survey measures were related to each other and to Census measures of concentrated poverty and racial segregation, but not so highly correlated as to be uniform. We found notable variation between community areas in women’s CD4 levels but there was no corresponding geographic variance in viral load, and relationships between community area measures and viral load disappeared after adjustment for individual characteristics, including HIV treatment adherence. In multilevel models adjusting for individual characteristics including substance use, depression and HIV treatment adherence, one survey measure of neighborhood disadvantage (poor quality built environment) and one Census measure (racial segregation) were significantly associated with greater likelihood of CD4<500 (p<.05).

Sustained HIV viral suppression among men who have sex with men in the Miami-Dade County Ryan White Program: the effect of demographic, psychosocial, provider and neighborhood factors

“…Our finding is inconsistent with one study of New York City surveillance data which suggested that while neighborhood poverty was not associated with achieving viral suppression, it was associated with lower likelihood of maintaining viral suppression after diagnosis [33]. However, the literature on the effect of neighborhoods on viral suppression is mixed with some studies showing an association between residing in areas of high deprivation and poor viral suppression [34,35], and others showing no association [36,37]. It is possible that neighborhood units smaller than the ZIP code or other neighborhood characteristics not measured in this study, particularly perceptions of one's neighborhood, may be important.…”

“…Characteristics of men who have sex with men by sustained viral load suppression, 2017 (n = 3386) Characteristics of men who have sex with men by sustained viral load suppression, 2017 (n = 3386) (Continued)In the multivariate analyses the odds of sustained viral suppression were lower for younger MSM (18-24 [aOR 0.51, 95% CI 0.34-0.77] and 25-34 [aOR 0.68, 95% CI 0.52-0.87] compared with[35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] year-olds) and for Black MSM compared with White MSM (aOR 0.44, 95% CI 0.29-0.69) (Table 2). Individuals not enrolled in the ACA (aOR 0.66, 95% CI 0.48-0.90), currently reporting Characteristics of men who have sex with men by sustained viral load suppression, 2017 (n = 3386) (Continued)…”

The relationship between adverse neighborhood socioeconomic context and HIV continuum of care outcomes in a diverse HIV clinic cohort in the Southern United States

“…Meanwhile, studies in Chicago, St. Louis, and Florida found no neighborhood characteristic associations with viral suppression (Burke-Miller et al, 2016; Shacham, Lian, Onen, Donovan, & Overton, 2013; Shacham, Lopez, Onen, & Overton, 2017; Sheehan, Fennie, Mauck, Maddox, Lieb, & Trepka, 2015). These more recent analyses generally agree with our own study findings, though only Sheehan et al explicitly evaluated retention in care, finding a null association for that outcome as well.…”

Relationships between neighbourhood characteristics and current STI status among HIV-infected and HIV-uninfected women living in the Southern USA: a cross-sectional multilevel analysis

“…3 An emerging line of multilevel research suggests that neighbourhood factors shape HIV care and treatment among HIV-infected populations: neighbourhood disadvantage is associated with lower CD4 counts and less ART initiation. 2829 …”