The Contribution of Socioeconomic Factors to HIV RNA Suppression in Persons with HIV Engaged in Care in the NA-ACCORD

Details

• Alternative Title:
  J Acquir Immune Defic Syndr
• Personal Author:
  Chandran, Aruna ; Feng, Xinyi ; Coburn, Sally B. ; Kasaie, Parastu ; Malone, Jowanna ; Horberg, Michael A. ; Hogan, Brenna ; Rebeiro, Peter F. ; Gill, M. John ; McGinnis, Kathleen A. ; Silverberg, Michael J. ; Karris, Maile Young ; Napravnik, Sonia ; Konkle-Parker, Deborah ; Lee, Jennifer ; Freeman, Aimee M. ; Ghidey, Ronel ; Garza, Venezia ; Marconi, Vincent C. ; Kirk, Gregory D. ; Thorne, Jennifer ; Crane, Heidi M. ; Lang, Raynell ; Kitahata, Mari M. ; Moore, Richard D. ; Althoff, Keri N.
• Description:
  Introduction
  
  Socioeconomic status (SES) influences well-being among people living with HIV (PWH); when individual-level SES information is not available, area-level SES indicators may be a suitable alternative. We hypothesized that: a) select ZIP Code-level SES indicators would be associated with viral suppression, and b) accounting for ZIP Code-level SES would attenuate racial disparities in viral suppression among PWH.
  
  Setting
  
  The NA-ACCORD, a collaboration of clinical and interval cohorts of PWH.
  
  Methods
  
  Participants with ≥1 viral load measurement and ≥1 US residential 5-digit ZIP Code(s) between 2010–2018 were included. In this serial cross-sectional analysis, multivariable logistic regression models were used to quantify the annual association of race and ethnicity with viral suppression, in the presence of SES indicators as well as sex, Hepatitis C status, and age.
  
  Results
  
  We observed a dose response relationship between SES factors and viral suppression. Lower income and education were associated with 0.5 to 0.7-fold annual decreases in odds of viral suppression. We observed racial disparities of ~40% decreased odds of viral suppression among non-Hispanic Black compared with non-Hispanic White individuals. The disparity persisted but narrowed by 3–4% when including SES in the models.
  
  Conclusion
  
  ZIP Code-based SES was associated with viral suppression, and accounting for SES narrowed racial disparities in viral suppression among PWH in the NA-ACCORD. Inclusion of ZIP Code-level indicators of SES as surrogates for individual-level SES should be considered to improve our understanding of the impact of social determinants of health and racial disparities on key outcomes among PWH in North America.
  
  
• Subjects:
  Adult Anti-HIV Agents Cross-Sectional Studies Female HIV Infections Humans Male Middle Aged RNA, Viral Socioeconomic Factors United States Viral Load

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• Source:
  J Acquir Immune Defic Syndr. 97(3):232-241
• Pubmed ID:
  39431507
• Pubmed Central ID:
  PMC11494146
• Document Type:
  Journal Article
• Funding:
  K23 EY013707/EY/NEI NIH HHSUnited States/ ; G12 MD007583/MD/NIMHD NIH HHSUnited States/ ; U01 AI038855/AI/NIAID NIH HHSUnited States/ ; UL1 RR024131/RR/NCRR NIH HHSUnited States/ ; U01 HL146192/HL/NHLBI NIH HHSUnited States/ ; U01 AI069432/AI/NIAID NIH HHSUnited States/ ; U01 HL146201/HL/NHLBI NIH HHSUnited States/ ; U01 AA020790/AA/NIAAA NIH HHSUnited States/ ; K01 AI131895/AI/NIAID NIH HHSUnited States/ ; F31 DA037788/DA/NIDA NIH HHSUnited States/ ; U01 HL146241/HL/NHLBI NIH HHSUnited States/ ; R01 AA016893/AA/NIAAA NIH HHSUnited States/ ; N01 CP001004/CP/NCI NIH HHSUnited States/ ; P30 AI027767/AI/NIAID NIH HHSUnited States/ ; P30 AI050409/AI/NIAID NIH HHSUnited States/ ; U01 HL146333/HL/NHLBI NIH HHSUnited States/ ; F31 AI124794/AI/NIAID NIH HHSUnited States/ ; P30 MH062246/MH/NIMH NIH HHSUnited States/ ; U01 AI069434/AI/NIAID NIH HHSUnited States/ ; 90047713/Agency for Healthcare Research and Quality/ ; R01 DA011602/DA/NIDA NIH HHSUnited States/ ; P30 AI094189/AI/NIAID NIH HHSUnited States/ ; U01 HL146245/HL/NHLBI NIH HHSUnited States/ ; K24 DA000432/DA/NIDA NIH HHSUnited States/ ; U01 HL146205/HL/NHLBI NIH HHSUnited States/ ; U01 DA036935/DA/NIDA NIH HHSUnited States/ ; U01 HL146208/HL/NHLBI NIH HHSUnited States/ ; U54 MD007587/MD/NIMHD NIH HHSUnited States/ ; U01AI069918/NH/NIH HHSUnited States/ ; R24 AI067039/AI/NIAID NIH HHSUnited States/ ; U01 HL146242/HL/NHLBI NIH HHSUnited States/ ; N02CP55504/CP/NCI NIH HHSUnited States/ ; U01 AI038858/AI/NIAID NIH HHSUnited States/ ; U10 EY008057/EY/NEI NIH HHSUnited States/ ; U01 AI068636/AI/NIAID NIH HHSUnited States/ ; U01 HL146193/HL/NHLBI NIH HHSUnited States/ ; U10 EY008052/EY/NEI NIH HHSUnited States/ ; P30 AI110527/AI/NIAID NIH HHSUnited States/ ; P30 AI027763/AI/NIAID NIH HHSUnited States/ ; K01 AI093197/AI/NIAID NIH HHSUnited States/ ; U01 AI069918/AI/NIAID NIH HHSUnited States/ ; K24 AI118591/AI/NIAID NIH HHSUnited States/ ; K24 AI065298/AI/NIAID NIH HHSUnited States/ ; U01 AA013566/AA/NIAAA NIH HHSUnited States/ ; UL1 TR000083/TR/NCATS NIH HHSUnited States/ ; P30 AI027757/AI/NIAID NIH HHSUnited States/ ; U01 HL146204/HL/NHLBI NIH HHSUnited States/ ; R01 DA012568/DA/NIDA NIH HHSUnited States/ ; U01 HL146202/HL/NHLBI NIH HHSUnited States/ ; CDC-200-2006-18797/CC/CDC HHSUnited States/ ; KL2 TR000421/TR/NCATS NIH HHSUnited States/ ; UL1 TR000004/TR/NCATS NIH HHSUnited States/ ; U01 HL146240/HL/NHLBI NIH HHSUnited States/ ; R01 AG053100/AG/NIA NIH HHSUnited States/ ; U10 EY008067/EY/NEI NIH HHSUnited States/ ; P30 AI036219/AI/NIAID NIH HHSUnited States/ ; Z01 CP010176/ImNIH/Intramural NIH HHSUnited States/ ; U01 HL146194/HL/NHLBI NIH HHSUnited States/ ; U24 AA020794/AA/NIAAA NIH HHSUnited States/ ; U01 HL146203/HL/NHLBI NIH HHSUnited States/ ; U01 AI068634/AI/NIAID NIH HHSUnited States/ ; P30 AI050410/AI/NIAID NIH HHSUnited States/
• Volume:
  97
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:758e527bab500d4df2010a1d69d5d62e8467cb6767d95d045a7ffdbaeb3dcf817e25705b52105bd6b0e5b8f64cd6fed34c8d96e520888c4a8fbe7e65c97c49e4
• Download URL:
  https://stacks.cdc.gov/view/cdc/166884/cdc_166884_DS1.pdf
• File Type:
  [PDF - 330.98 KB ]