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Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression
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Details:
  • Pubmed ID:
    25867777
  • Pubmed Central ID:
    PMC4568746
  • Funding:
    K23-MH097647/MH/NIMH NIH HHS/United States
    P30 AI045008/AI/NIAID NIH HHS/United States
    P30 AI087714/AI/NIAID NIH HHS/United States
    P30 MH097488/MH/NIMH NIH HHS/United States
    P30-AI-087714/AI/NIAID NIH HHS/United States
    P30-AI-45008/AI/NIAID NIH HHS/United States
    PS13-130202/PS/NCHHSTP CDC HHS/United States
    U62/003959/PHS HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Background

    Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots.

    Methods

    Retrospective cohort of 1,404 persons newly diagnosed with HIV in 2008–2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention in care and residence in a hotspot associated with poor viral suppression.

    Results

    24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared to 40.4% of those residing outside hotspots (p<0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared to 75.3% of those outside hotspots (p<.0.05). Factors significantly associated with residence in a poor retention hotspots included: female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in a poor viral suppression hotspots included; female sex, higher economic deprivation, and shorter distance to pharmacies.

    Conclusions

    Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention in care and viral suppression.