The Association Between the Social Determinants of Health and HIV Control in Miami-Dade County ZIP Codes, 2017

Abstract

Background There were 28,055 people living with HIV (PLWH) in Miami-Dade County (MDC) in 2017; 40.1% was either out of care or was not virally suppressed (uncontrolled HIV). The purpose of this study was to determine the association between the social determinants of health (SDOH) and the number of persons with uncontrolled HIV in MDC. Setting This cross-sectional study included PLWH 15 and older with uncontrolled HIV in MDC, 2017. Data on PLWH’s viral load, age, gender, mode of HIV transmission, and race/ethnicity were aggregated to the ZIP code level. All five SDOH per HealthyPeople 2020 were represented: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment. Methods Descriptive analyses on all study variables and a principal component analysis on the SDOH variables were performed. To account for overdispersion, multivariate negative binomial regressions were run while controlling for confounders and testing for significant interactions. Results The results of the regression analysis indicated that an increase in Factor 1 (economic stability, education, and health and healthcare determinants) was associated with a statistically significant increase in the number of PLWH with uncontrolled HIV. Additionally, we found a significant interaction between Factor 1 and White race. Among persons of low socioeconomic status, White race is associated with a reduction in PLWH with uncontrolled HIV. Conclusions These results suggest that reducing poverty and increasing education and rates of health insurance should result in significant reductions in PLWH with uncontrolled HIV. These results have the potential to influence future policy, interventions for retention, adherence, and continuity of care to improve suppression rates in MDC.

Effect of Social Determinants of Health on Uncontrolled Human Immunodeficiency Virus (HIV) Infection Among Persons With HIV in San Francisco, California

“…However, although some studies have explored how various demographic factors impact HIV outcomes and treatment adherence among PWH [ 24 , 27 , 28 ], fewer have focused on how SDH factors contribute to the successful control of chronic HIV infection [ 24 , 28 ]. Ecological research previously used principal component analysis to identify communities with lower combined economic stability, education levels, and access to health insurance to have higher rates of uncontrolled HIV [ 24 ]. Our study found similar results in a case-based analysis that modeled each community-level SDH metric on its own.…”

“…Uncontrolled HIV was defined based on Rojas et al [ 24 ], with slight modification, using participants’ most recent viral load test and CD4 test during the study period ( Supplemental Figure 1 ). A participant was determined to have controlled HIV if their latest viral load test result was undetectable, defined as <200 copies/mL.…”

“…Many US studies have investigated SDH among newly diagnosed PWH [ 13–23 ], but few have included those with previously diagnosed HIV infection [ 24 ]. Although focusing on those newly diagnosed provides insights into people with recent infection and can inform HIV prevention and testing initiatives, it does not address the much larger number of individuals who are living with HIV but were infected in years past.…”

Social Determinants of Disease: HIV and COVID-19 Experiences

“…Researchers examining the cause behind rising HIV diagnoses and death rates among GBMSM of color, particularly in the deep US southern states, point to the higher-than-average poverty rate and limited opportunities for employment, health care access, and educational achievement [67]. Lastly, people living with HIV (PLWH) appear to be more susceptible to the negative effects of living in high poverty areas as it is associated with lower quality of life [69], unsuppressed viral load and poorer linkage to HIV care [70][71][72], as well as inadequate social support and health service utilization [73,74]. Conversely, employment stability has been shown to improve or maintain HIV care engagement among PLWH [75,76].…”

The Magnetic Couples Study: protocol for a mixed methods prospective cohort study of HIV-serodifferent heterosexual couples’ perspectives and use of pre-exposure prophylaxis (PrEP)

“…23 31 Barriers to sustained undetectable viral load include social determinants of health including racism, homelessness, poverty and access to medical care, which can inhibit one's ability to adhere to a daily medication regimen. [32][33][34][35] Oral HIV pre-exposure prophylaxis (PrEP; 200 mg emtricitabine (FTC) in combination with 300 mg tenofovir disoproxil fumarate (TDF) or 25 mg tenofovir alafenamide (TAF)) has been added to the HIV prevention toolbox within the last decade. When taken daily as an oral medication, PrEP has demonstrated high levels of efficacy (>95%) in preventing HIV transmission among HIV-serodifferent heterosexual couples.…”