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

dc.contributor.authorRebeiro, Peter F.
dc.contributor.authorHowe, Chanelle J.
dc.contributor.authorRogers, William B.
dc.contributor.authorBebawy, Sally S.
dc.contributor.authorTurner, Megan
dc.contributor.authorKheshti, Asghar
dc.contributor.authorMcGowan, Catherine C.
dc.contributor.authorRaffanti, Stephen P.
dc.contributor.authorSterling, Timothy R.
dc.contributor.departmentMedicine, School of Medicineen_US
dc.date.accessioned2020-01-06T16:43:47Z
dc.date.available2020-01-06T16:43:47Z
dc.date.issued2018-11
dc.description.abstractRetention in care and viral suppression are critical to delaying HIV progression and reducing transmission. Neighborhood socioeconomic context (NSEC) may affect HIV care receipt. We therefore assessed NSEC's impact on retention and viral suppression in a diverse HIV clinical cohort. HIV-positive adults with ≥1 visit at the Vanderbilt Comprehensive Care Clinic and 5-digit ZIP code tabulation area (ZCTA) information between 2008 and 2012 contributed. NSEC z-score indices used neighborhood-level socioeconomic indicators for poverty, education, labor-force participation, proportion of males, median age, and proportion of residents of black race by ZCTA. Retention was defined as ≥2 HIV care visits per calendar year, >90 days apart. Viral suppression was defined as an HIV-1 RNA <200 copies/mL at last measurement per calendar year. Modified Poisson regression was used to estimate risk ratios (RR) and 95% confidence intervals (CI). Among 2272 and 2541 adults included for retention and viral suppression analyses, respectively, median age and CD4 count at enrollment were approximately 38 (1st and 3rd quartile: 30, 44) years and 351 (176, 540) cells/μL, respectively, while 24% were female, and 39% were black. Across 243 ZCTAs, median NSEC z-score was 0.09 (-0.66, 0.48). Overall, 79% of person-time contributed was retained and 74% was virally suppressed. In adjusted models, NSEC was not associated with retention, though being in the 4th vs. 1st NSEC quartile was associated with lack of viral suppression (RR = 0.88; 95% CI: 0.80-0.97). Residing in the most adverse NSEC was associated with lack of viral suppression. Future studies are needed to confirm this finding.en_US
dc.eprint.versionAuthor's manuscripten_US
dc.identifier.citationRebeiro, P. F., Howe, C. J., Rogers, W. B., Bebawy, S. S., Turner, M., Kheshti, A., … Sterling, T. R. (2018). The relationship between adverse neighborhood socioeconomic context and HIV continuum of care outcomes in a diverse HIV clinic cohort in the Southern United States. AIDS care, 30(11), 1426–1434. doi:10.1080/09540121.2018.1465526en_US
dc.identifier.urihttps://hdl.handle.net/1805/21747
dc.language.isoen_USen_US
dc.publisherTaylor & Francisen_US
dc.relation.isversionof10.1080/09540121.2018.1465526en_US
dc.relation.journalAIDS Careen_US
dc.rightsPublisher Policyen_US
dc.sourcePMCen_US
dc.subjectHIV continuum of careen_US
dc.subjectSouthern USen_US
dc.subjectNeighborhood risken_US
dc.subjectRetention in careen_US
dc.subjectViral suppressionen_US
dc.titleThe relationship between adverse neighborhood socioeconomic context and HIV continuum of care outcomes in a diverse HIV clinic cohort in the Southern United Statesen_US
dc.typeArticleen_US
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