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AHONKHAI AA, BIAN A, ROBBINS NN, MAURER LA, CLOUSE K, PIERCE LJ, PERKINS JM, WERNKE SA, SHEPHERD BE, BRANTLEY M. Characterizing residential mobility among people with HIV in Tennessee and its impact on HIV care outcomes. AIDS 2024; 38:397-405. [PMID: 37916463 PMCID: PMC10872643 DOI: 10.1097/qad.0000000000003778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVE Our objective was to assess the prevalence and patterns of mobility among people with HIV (PWH) in Tennessee and its impact on HIV care outcomes. DESIGN Retrospective cohort study. METHODS We combined residential address and HIV surveillance data from PWH in Tennessee from 2016 to 2018. Using Poisson regression, we estimated associations between in-state mobility (change in address or total miles moved) in 1 year and outcomes in the subsequent year; retention: having two CD4 + /HIV RNA values (labs) in a calendar year at least 3 months apart, loss to follow-up (LTFU): having labs at baseline but not the subsequent year, and viral suppression: HIV RNA less than 200 copies/ml. We applied a kernel density estimator to origin-destination address lines to visualize mobility patterns across demographic subgroups. RESULTS Among 17 428 PWH [median age 45 years (interquartile range; IQR 34-53)], 6564 (38%) had at least one move. Median miles moved was 8.9 (IQR 2.6-143.4)). We observed in-state movement between major cities (Chattanooga, Knoxville, Memphis and Nashville) and out-of-state movement to and from Georgia and Florida. Having at least one in-state move was associated with a decreased likelihood of retention [adjusted relative risk (aRR) = 0.91; 95% confidence interval (CI) 0.88-0.95], and an increased risk of LTFU (aRR = 1.17; 95% CI 1.04-1.31, two to three moves vs. none). Greater distance moved in-state was associated with decreased retention and increased LTFU (aRR = 0.53; 95% CI 0.49-0.58, aRR = 2.52; 95% CI 2.25-2.83, respectively for 1000 vs. 0 miles). There was no association between mobility and viral suppression. CONCLUSION Mobility is common among PWH in Tennessee and is associated with initial poor engagement in HIV care.
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Affiliation(s)
- Aima A. AHONKHAI
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Aihua BIAN
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Kate CLOUSE
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
- Vanderbilt University School of Nursing, Nashville, TN
| | - Leslie J. PIERCE
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Jessica M. PERKINS
- Department of Human & Organizational Development, Peabody College, Vanderbilt University, Nashville, TN
| | - Steven A. WERNKE
- Department of Anthropology, Vanderbilt University, Nashville, TN
| | - Bryan E. SHEPHERD
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
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Park JW, Wilson-Barthes MG, Dulin AJ, Hogan JW, Mugavero MJ, Napravnik S, Carey MP, Fava JL, Dale SK, Earnshaw VA, Johnson B, Dougherty-Sheff S, Agil D, Howe CJ. Multilevel Resilience and HIV Virologic Suppression Among African American/Black Adults in the Southeastern United States. J Racial Ethn Health Disparities 2024; 11:313-325. [PMID: 37043167 PMCID: PMC10092932 DOI: 10.1007/s40615-023-01520-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To assess overall and by neighborhood risk environments whether multilevel resilience resources were associated with HIV virologic suppression among African American/Black adults in the Southeastern United States. SETTING AND METHODS This clinical cohort sub-study included 436 African American/Black participants enrolled in two parent HIV clinical cohorts. Resilience was assessed using the Multilevel Resilience Resource Measure (MRM) for African American/Black adults living with HIV, where endorsement of a MRM statement indicated agreement that a resilience resource helped a participant continue HIV care despite challenges or was present in a participant's neighborhood. Modified Poisson regression models estimated adjusted prevalence ratios (aPRs) for virologic suppression as a function of categorical MRM scores, controlling for demographic, clinical, and behavioral characteristics at or prior to sub-study enrollment. We assessed for effect measure modification (EMM) by neighborhood risk environments. RESULTS Compared to participants with lesser endorsement of multilevel resilience resources, aPRs for virologic suppression among those with greater or moderate endorsement were 1.03 (95% confidence interval: 0.96-1.11) and 1.03 (0.96-1.11), respectively. Regarding multilevel resilience resource endorsement, there was no strong evidence for EMM by levels of neighborhood risk environments. CONCLUSIONS Modest positive associations between higher multilevel resilience resource endorsement and virologic suppression were at times most compatible with the data. However, null findings were also compatible. There was no strong evidence for EMM concerning multilevel resilience resource endorsement, which could have been due to random error. Prospective studies assessing EMM by levels of the neighborhood risk environment with larger sample sizes are needed.
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Affiliation(s)
- Jee Won Park
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
- Program in Epidemiology, University of Delaware, Newark, DE, USA
| | - Marta G Wilson-Barthes
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA
| | - Akilah J Dulin
- Center for Health Promotion and Health Equity, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joseph W Hogan
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sonia Napravnik
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael P Carey
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Joseph L Fava
- Center for Behavioral and Preventive Medicine, Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital, Providence, RI, USA
| | - Sannisha K Dale
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Bernadette Johnson
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah Dougherty-Sheff
- Division of Infectious Diseases, Department of Medicine, Center for AIDS Research, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Deana Agil
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chanelle J Howe
- Center for Epidemiologic Research, Department of Epidemiology, School of Public Health, Brown University, Box G-S121-2, 121 South Main Street, Providence, RI, USA.
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Rich KM, Pandya A, Chiosi JJ, Reddy KP, Shebl FM, Ciaranello AL, Neilan AM, Pinkney JA, Losina E, Freedberg KA, Ahonkhai AA, Hyle EP. Projected Life Expectancy Gains From Improvements in HIV Care in Black and White Men Who Have Sex With Men. JAMA Netw Open 2023; 6:e2344385. [PMID: 38015507 PMCID: PMC10685884 DOI: 10.1001/jamanetworkopen.2023.44385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Substantial racial inequities exist across the HIV care continuum between non-Hispanic Black and White men who have sex with men (MSM) in the US. Objectives To project years of life gained (YLG) with improving the HIV care continuum among Black MSM and White MSM in the US and to determine the outcomes of achieving health equity goals. Design, Setting, and Participants The Cost-Effectiveness of Preventing AIDS Complications microsimulation model was used and populated with 2021 race-specific data to simulate HIV care among Black MSM and White MSM in the US who have acquired HIV. Analyses were completed from July 2021 to October 2023. Intervention The study simulated status quo care using race-specific estimates: age at infection, time to diagnosis, receipt of care, and virologic suppression. The study next projected the outcomes of attaining equity-centered vs non-equity-centered goals by simulating 2 equal improvements in care goals: (10-point increased receipt of care and 5-point increased virologic suppression), 3 equity-centered goals (annual HIV testing, 95% receiving HIV care, and 95% virologic suppression) and lastly, an equitable care continuum that achieves annual HIV testing, 95% receiving care, and 95% virologic suppression in Black MSM and White MSM. One-way and multiway sensitivity and scenario analyses were conducted. Main Outcomes and Measures Mean age at death and YLG. Results In the simulated cohort, the mean (SD) age at HIV infection was 27.0 (10.8) years for Black MSM and 35.5 (13.6) years for White MSM. In status quo, mean age at death would be 68.8 years for Black MSM and 75.6 years for White MSM. The equal improvements in care goals would result in 0.5 YLG for Black MSM and 0.5 to 0.9 YLG for White MSM. Achieving any 1 equity-centered goal would result in 0.5 to 1.7 YLG for Black MSM and 0.4 to 1.3 YLG for White MSM. With an equitable care continuum compared with the nationally reported status quo, Black MSM and White MSM would gain 3.5 and 2.1 life-years, respectively. If the status quo HIV testing was every 6 years with 75% retained in care and 75% virologically suppressed, Black MSM would gain 4.2 life-years with an equitable care continuum. Conclusions and Relevance In this simulation modeling study of HIV care goals, equal improvements in HIV care for Black and White MSM maintained or worsened inequities. These results suggest that equity-centered goals for the HIV care continuum are critical to mitigate long-standing inequities in HIV outcomes.
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Affiliation(s)
- Katherine M. Rich
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Ankur Pandya
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - John J. Chiosi
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Krishna P. Reddy
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston
| | - Fatma M. Shebl
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Andrea L. Ciaranello
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Anne M. Neilan
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston
| | - Jodian A. Pinkney
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
| | - Elena Losina
- Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Boston University School of Public Health, Massachusetts
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
- Policy and Innovation Evaluation in Orthopedic Treatments (PIVOT) Center, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kenneth A. Freedberg
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
| | - Aima A. Ahonkhai
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily P. Hyle
- Medical Practice Evaluation Center (MPEC), Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard University Center for AIDS Research, Harvard University, Boston, Massachusetts
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Martinez O, Munoz-Laboy M, Davison R. Medical-legal partnerships: An integrated approach to advance health equity and improve health outcomes for people living with HIV. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:871101. [PMID: 36303611 PMCID: PMC9580720 DOI: 10.3389/frph.2022.871101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Medical Legal Partnerships (MLPs) offer a structural integrated intervention that could facilitate improvements in medical and psychosocial outcomes among people living with HIV (PLWH). Through legal aid, MLPs can ensure that patients are able to access HIV services in a culturally sensitive environment. We conducted organizational-level qualitative research rooted in grounded theory, consisting of key informant interviews with MLP providers (n = 19) and members of the Scientific Collaborative Board (SCB; n = 4), site visits to agencies with MLPs (n = 3), and meetings (n = 4) with members of the SCB. Four common themes were identified: (1) availability and accessibility of legal and social services support suggest improvements in health outcomes for PLWH; (2) observations and experiences reveal that MLPs have a positive impact on PLWH; (3) 3 intersecting continua of care exist within MLPs: HIV care continuum; legal continuum of care; and social services continuum; and (4) engagement in care through an MLP increases patient engagement and community participation. The MLP approach as a structural intervention has the potential to alleviate barriers to HIV/AIDS treatment and care and thus dramatically improve health outcomes among PLWH.
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Affiliation(s)
- Omar Martinez
- College of Medicine, University of Central Florida, Orlando, FL, United States,*Correspondence: Omar Martinez
| | - Miguel Munoz-Laboy
- School of Social Welfare, Stony Brook University, Stony Brook, NY, United States
| | - Robin Davison
- College of Medicine, University of Central Florida, Orlando, FL, United States
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Melo JS, Hessol NA, Pipkin S, Buchbinder SP, Hsu LC. EFFECT OF SOCIAL DETERMINANTS OF HEALTH ON UNCONTROLLED HIV INFECTION AMONG PERSONS LIVING WITH HIV IN SAN FRANCISCO, CA, USA. Open Forum Infect Dis 2022; 9:ofac312. [PMID: 35899287 PMCID: PMC9310268 DOI: 10.1093/ofid/ofac312] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/22/2022] [Indexed: 11/14/2022] Open
Abstract
Background In 2010–2014, the San Francisco Department of Public Health (SFDPH) established programs to rapidly link people with human immunodeficiency virus (PWH) to care and offer antiretroviral therapy (ART) at human immunodeficiency virus (HIV) diagnosis. Such programs reduced the number of PWH out of care or with detectable HIV viral load (ie, uncontrolled HIV infection). We investigated the role of social determinants of health (SDH) on uncontrolled HIV. Methods Cross-sectional data from adult PWH diagnosed and reported to the SFDPH as of December 31, 2019, prescribed ART, and with confirmed San Francisco residency during 2017–2019 were analyzed in conjunction with SDH metrics derived from the American Community Survey 2015–2019. We focused on 5 census tract-level SDH metrics: percentage of residents below the federal poverty level, with less than a high school diploma, or uninsured; median household income; and Gini index. We compared uncontrolled HIV prevalence odds ratios (PORs) across quartiles of each metric independently using logistic regression models. Results The analysis included 7486 PWH (6889 controlled HIV; 597 uncontrolled HIV). Unadjusted PORs of uncontrolled HIV rose with increasingly marginalized quartiles, compared to the least marginalized quartile for each metric. Adjusting for demographics and transmission category, the POR for uncontrolled HIV for PWH in the most marginalized quartile remained significant across metrics for poverty (POR = 2.0; confidence interval [CI] = 1.5–2.6), education (POR = 2.4; CI = 1.8–3.2), insurance (POR = 1.8; CI = 1.3–2.5), income (POR = 1.8; CI = 1.4–2.3), and income inequality (POR = 1.5; CI = 1.1–2.0). Conclusions Beyond demographics, SDH differentially affected the ability of PWH to control HIV. Despite established care programs, PWH experiencing socioeconomic marginalization require additional support to achieve health outcome goals.
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Affiliation(s)
- Jason S Melo
- San Francisco Department of Public Health , San Francisco, CA , USA
| | - Nancy A. Hessol
- Department of Medicine, University of California San Francisco , San Francisco, CA , USA
- Department of Clinical Pharmacy, University of California San Francisco , San Francisco, CA , USA
| | - Sharon Pipkin
- San Francisco Department of Public Health , San Francisco, CA , USA
| | - Susan P. Buchbinder
- San Francisco Department of Public Health , San Francisco, CA , USA
- Department of Medicine, University of California San Francisco , San Francisco, CA , USA
- Department of Epidemiology and Biostatistics, University of California San Francisco , San Francisco, CA , USA
| | - Ling C. Hsu
- San Francisco Department of Public Health , San Francisco, CA , USA
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