Social Determinants of Health and Care Outcomes Among People With HIV in the United States

Abstract

Background Fewer than 70% of people living with HIV (PLHIV) in the United States have achieved durable viral suppression. To end the HIV epidemic in the United States, clinicians, researchers, and public health practitioners must devise ways to remove barriers to effective HIV treatment. To identify PLHIV who experience challenges to accessing healthcare, we created a simple assessment of social determinants of health (SDOH) among PLHIV and examined the impact of cumulative social and economic disadvantage on key HIV care outcomes. Methods We used data from the 2015-2019 Medical Monitoring Project, a yearly cross-sectional survey of PLHIV in the United States (N=15,964). We created a ten-item index of SDOH and assessed differences in HIV care outcomes of missed medical appointments, medication adherence, and durable viral suppression by SDOH using this index using prevalence ratios with predicted marginal means. Results Eighty-three percent of PLHIV reported at least one SDOH indicator. Compared to PLHIV who experienced none of the SDOH indicators, people who experienced one, two, three, and four or more SDOH indicators, were 1.6, 2.1, 2.6 and 3.6 as likely to miss a medical appointment in the prior year; 11%, 17%, 20% and 31% less likely to report excellent adherence in the prior 30 days; and, 2%, 4%, 10% and 20% less likely to achieve durable viral suppression in the prior year, respectively. Conclusions Among PLHIV, cumulative exposure to social and economic disadvantage impacts care outcomes in a dose-dependent fashion. A simple index may identify PLHIV experiencing barriers to HIV care, adherence, and durable viral suppression in need of critical supportive services.

COVID-19 Vaccine Uptake Among People Living with HIV

“…Of 8,022 PLWH, 4943 (61.6%; 95%CI 60.5-62.7%) received at least one COVID-19 vaccine dose and 4538 (56.6%; 95%CI 55. 5 The percentage of PLWH who received at least one COVID-19 vaccine dose ranged from 30.9% among those without a CD4 count and viral load measurement in 2020 to 78.1% among those who received an influenza vaccine in 2019-2020. Compared to PLWH 18-29 years old, vaccination was more likely among PLWH aged 50 years old and older.…”

“…In addition, PLWH with lower CD4 counts may mount an inadequate response to vaccination and may require increased support to complete a newly recommended three-dose vaccination series for people with untreated or advanced HIV. Social determinants of health affecting uptake of COVID-19 vaccination likely overlap with those affecting clinic attendance, antiretroviral adherence, and viral suppression [5]. In contrast, ADAP enrollment was associated with greater vaccine uptake; case workers facilitate access to vaccination through assistance with finding vaccination sites, appointment scheduling, and transportation.…”

“…Third, PLWH are more likely to experience comorbid medical conditions and experience them at a younger age compared to those without HIV [4]. Fourth, PLWH are more likely to experience social and economic disadvantage than those without HIV [5] and this disadvantage is associated with a greater risk of COVID-19 [6]. Finally, HIV is more common among Black, Hispanic/Latinx, Indigenous and LGBTQ + communities all of whom have shouldered the burden of the COVID-19 pandemic in Oregon and across the United States [7,8].…”

Health Literacy, Health Outcomes and Community Health Worker Utilization in HIV Primary Care

“…These needs, or social determinants of health (SDOH), encapsulate a wide range of economic, social, and environmental factors 31,32 . In a study of 15,964 PWH in the United States, 23% reported at least one SDOH indicator, while 25% indicated 4 or more indicators 30 . Further, 31.7% had di culties with transportation, which is consistent with the 32.5% of our cohort who received transportation coordination from a CHW 30 .…”

“…In a study of 15,964 PWH in the United States, 23% reported at least one SDOH indicator, while 25% indicated 4 or more indicators 30 . Further, 31.7% had di culties with transportation, which is consistent with the 32.5% of our cohort who received transportation coordination from a CHW 30 . Our data demonstrate that emotional support was the most commonly reported purpose of CHW encounter.…”