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Kimaru LJ, Habila MA, Mantina NM, Madhivanan P, Connick E, Ernst K, Ehiri J. Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002870. [PMID: 38349915 PMCID: PMC10863897 DOI: 10.1371/journal.pgph.0002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
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Affiliation(s)
- Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Magdiel A. Habila
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - Namoonga M. Mantina
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth Connick
- Department of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Kacey Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - John Ehiri
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
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Lee Y, Walton R, Jackson L, Batey DS. Community-Level Factors and HIV Health Among Older People Living With HIV (PLWH) in Alabama, United States: A Qualitative Analysis. J Assoc Nurses AIDS Care 2021; 32:589-598. [PMID: 33009174 DOI: 10.1097/jnc.0000000000000214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT As the number of older people living with HIV (PLWH) is increasing, there is an urgent need for research on community-level factors to better understand the health care needs of this population. In-depth interview transcripts of 20 older PLWH who participated in a community-based participatory research study conducted in Alabama, in the United States, were analyzed through a phenomenological research approach. Results suggest that crime, lack of resources, and social isolation experienced at the community levels were found to be associated with the wellbeing of older PLWH. Moreover, community characteristics may confound older PLWH's comorbid conditions and resultant polypharmacy. An increased understanding of the impact of contextual factors on HIV health can inform more holistic individual- and community-level interventions aimed at addressing barriers to retention or re-engagement in HIV medical care and viral suppression among older PLWH.
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Affiliation(s)
- Yookyong Lee
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rick Walton
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsey Jackson
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - D Scott Batey
- Yookyong Lee, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rick Walton is a community member, Birmingham, Alabama, USA
- Lindsey Jackson, MPH, is the Hep C Project Director, Birmingham AIDS Outreach, Birmingham, Alabama, USA
- D. Scott Batey, PhD, MSW, is an Associate Professor, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rebeiro PF, Howe CJ, Rogers WB, Bebawy SS, Turner M, Kheshti A, McGowan CC, Raffanti SP, Sterling TR. 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 2018; 30:1426-1434. [PMID: 29678121 DOI: 10.1080/09540121.2018.1465526] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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.
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Affiliation(s)
- Peter F Rebeiro
- a Medicine, Infectious Diseases , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Chanelle J Howe
- b Epidemiology , Brown University School of Public Health , Providence , RI , USA
| | - William B Rogers
- c Medicine , Indiana University School of Medicine , Indianapolis , IN , USA
| | - Sally S Bebawy
- a Medicine, Infectious Diseases , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Megan Turner
- a Medicine, Infectious Diseases , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Asghar Kheshti
- a Medicine, Infectious Diseases , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Catherine C McGowan
- a Medicine, Infectious Diseases , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Stephen P Raffanti
- a Medicine, Infectious Diseases , Vanderbilt University School of Medicine , Nashville , TN , USA
| | - Timothy R Sterling
- a Medicine, Infectious Diseases , Vanderbilt University School of Medicine , Nashville , TN , USA
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