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

ABSTRACT

Retention 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.

KEYWORDS:

• HIV continuum of care
• retention in care
• viral suppression
• neighborhood risk
• Southern US

Acknowledgements

We thank Dr. Akilah Dulin-Keita for her guidance in constructing the neighborhood socioeconomic context score.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Peter F. Rebeiro http://orcid.org/0000-0003-1951-9104

Additional information

Funding

This work was supported by National Institute of Allergy and Infectious Diseases: [Grant Number K01-AI131895, P30-AI110527, U01-AI069923]. This work was supported in part by the National Institutes of Health (Tennessee Center for AIDS Research, P30-AI110527; Rebeiro, K01-AI131895). This work was also supported by the NIH-funded Caribbean, Central and South America network for HIV epidemiology (CCASAnet), a member cohort of the International Epidemiologic Databases to Evaluate AIDS (leDEA)(U01-AI069923). This award is funded by the following institutes: Eunice Kennedy Shriver National Institute Of Child Health & Human Development (NICHD), National Cancer Institute (NCI), National Institute Of Allergy And Infectious Diseases (NIAID), National Institute Of Mental Health (NIMH), and the Office Of The Director, National Institutes Of Health (OD).