Retention in HIV Care and Viral Suppression: Individual- and Neighborhood-Level Predictors of Racial/Ethnic Differences, Florida, 2015

Abstract

The objective of this study was to estimate racial/ethnic differences in retention in HIV care and viral suppression and to identify related individual and neighborhood determinants. Florida HIV surveillance records of cases aged ≥13 years diagnosed during the years 2000-2014 were analyzed. Retention in care was defined as evidence of ≥2 or more laboratory tests, receipts of prescription, or clinical visits at least 3 months apart during 2015. Viral load suppression was defined as a viral load of <200 copies/mL for the last test in 2015. Multi-level logistic regressions were used to estimate adjusted odds ratios (AORs). Of 65,735 cases, 33.3% were not retained in care, and 40.1% were not virally suppressed. After controlling for individual and neighborhood factors, blacks were at increased odds of nonretention in HIV care [AOR 1.29, 95% confidence interval (CI) 1.23-1.35] and nonviral suppression (AOR 1.55, 95% CI 1.48-1.63) compared with whites. Black and Latino males compared with their female counterparts had higher odds of nonretention and nonviral suppression. Compared with their US-born counterparts, foreign-born blacks and whites, but not Latinos, had higher odds of nonretention and nonviral suppression. Blacks and whites in urban compared with rural areas had higher odds of both outcomes. Disparities in retention in care and viral suppression persist and are not accounted for by differences in age, sex, transmission mode, AIDS diagnosis, neighborhood socioeconomic status, rural/urban residence, or neighborhood racial composition. Further, predictors of poor retention in care and viral suppression appear to differ by race/ethnicity.

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)…”

Improving HIV Care Engagement in the South from the Patient and Provider Perspective: The Role of Stigma, Social Support, and Shared Decision-Making

“…The investigators chose to exclude Spanish-speaking participants from this study because care engagement in Spanishspeaking people living with HIV, who are more likely to be recent immigrants, has been shown to differ from Englishspeaking Latinos. 25 A separate interview guide would be necessary to address topics of patient/provider language barriers, the role of documentation status, care engagement, and culture/acculturation, and a separate recruitment strategy would be needed to sample this subpopulation (<10% of the overall clinics' clients), which was beyond the scope of this analysis. 26,27 From each site, 10 patient participants were interviewed who missed their IMV following their case management intake visit, defined as no-show for the IMV without cancelation by patient or provider (Missed).…”

PositiveLinks: A Mobile Health Intervention for Retention in HIV Care and Clinical Outcomes with 12-Month Follow-Up

“… 8 Racial and ethnic disparities remain an issue in HIV care in the United States, where black and Latino patients have lower rates of retention in care and viral suppression than white patients. 9 Discontinuity of care is higher for male than female patients and higher for black than non-black patients. 10 Nonwhite race is a risk factor for poor ART adherence, in addition to psychosocial factors of self-efficacy, depression, stigma, and stressful life events.…”