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Owens C, Hurtado M, Moskowitz DA, Mustanski B, Macapagal K. Rural-Urban Differences in HIV Sexual Risk Behaviors and HIV Service Utilization Among Adolescent Sexual Minority Males in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2765-2775. [PMID: 38528296 DOI: 10.1007/s10508-024-02840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
In the United States, HIV prevalence is increasing in rural areas, specifically among rural adolescent sexual minority males (ASMM). However, it is unclear what HIV sexual risk behaviors rural ASMM engage in and what HIV preventative services they utilize. This study aimed to (1) document the lifetime HIV sexual risk behaviors and service utilization of rural ASMM and (2) compare rural-urban differences in the prevalence of HIV sexual risk behaviors and service utilization. We analyzed data collected from 1615 ASMM who participated in a baseline survey for an online HIV prevention program from April 2018 to June 2020. We compared the prevalence of lifetime HIV sexual risk behaviors and HIV healthcare utilization among rural and urban participants via descriptive statistics, chi-square tests, linear and logistic regressions, and zero-inflated Poisson regressions. These analyses indicated that rural ASMM were more likely than urban ASMM to engage in condomless sex when they had anal sex. Rural ASMM could benefit from offline and online evidence-based HIV prevention interventions, especially interventions that increase condom use.
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Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Manuel Hurtado
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
| | - David A Moskowitz
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA.
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave., Suite 1400, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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2
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Zhang C, Yan Y, Zhu X, Li L, Li Y, Wang G, He F, Song Y, Liu Y, Zhang N. Evaluating the spatial accessibility and spatial layout optimization of HIV/AIDS healthcare services in Shandong Province, China. Sci Rep 2024; 14:11258. [PMID: 38755199 PMCID: PMC11099158 DOI: 10.1038/s41598-024-61484-7] [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: 01/04/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Improving access to HIV/AIDS healthcare services is of great concern to government and policymakers striving to strengthen overall public health. How to reasonably allocate HIV/AIDS healthcare resources and maximize the equality of access to healthcare services across subdistrict areas has become an urgent problem to be solved. However, there is limited research on this topic in China. It is necessary to evaluate spatial accessibility to improve the accessibility and equity of HIV/AIDS healthcare services. In this study, the improved multi-modal two-step floating catchment area (2SFCA) and inverted 2SFCA (i2SFCA) methods are used to measure the spatial accessibility of HIV/AIDS healthcare services and the crowdedness of the healthcare sites in Shandong Province, China. Then, the theoretical supply and the optimal spatial distribution of resources are calculated and visualized by minimizing the accessibility gaps between demand locations. This study showed that the spatial accessibility of HIV/AIDS service resources in Shandong Province was concentrated and unevenly distributed, and the accessibility scores in the marginal areas of prefecture-level cities were significantly lower than those in other areas. Regions with a large number of doctors had significantly higher levels of spatial accessibility. The ART accessibility scores in the southwest of Shandong Province were higher than those in other regions. As the travel friction coefficient increased, the accessibility scores formed an approximately circular cluster distribution centered on the healthcare sites in geographical distribution. More ART drugs needed to be supplied in marginal areas and more doctors were needed to work on HIV/AIDS in urban areas to address the spatial distribution imbalance of HIV/AIDS healthcare services. This study profoundly analyzed the spatial accessibility of HIV/AIDS healthcare services and provided essential references for decision-makers. In addition, it gives a significant exploration for achieving the goal of equal access to HIV/AIDS healthcare services in the future.
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Affiliation(s)
- Chao Zhang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Yujie Yan
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Yajun Li
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China
| | - Fenfen He
- Department of Occupational and Environmental Health and the Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Fourth Military Medical University, Xi'an, China
| | - Yining Song
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Institute for Medical Dataology, Cheeloo College of Medicine, Shandong University, Jinan, 250000, Shandong, China.
- Climate Change and Health Center, Shandong University, Jinan, Shandong Province, China.
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, 250014, Shandong, China.
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Wang C, Prigozhina A, Leitner M. Measuring Spatial Access of Vulnerable Population to HIV Testing Facilities in the Baton Rouge Metropolitan Statistical Area, Louisiana. AIDS Behav 2024:10.1007/s10461-024-04304-3. [PMID: 38605253 DOI: 10.1007/s10461-024-04304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 04/13/2024]
Abstract
Ensuring adequate and equitable access to affordable HIV testing is a crucial step toward ending the HIV epidemic (EHE). Using the high-burden Baton Rouge Metropolitan Statistical Area (MSA) as an example, we measure spatial access to HIV testing facilities for vulnerable populations and assess whether their access would improve if eliminating a considerable barrier-costs. Locations and status (free, low-cost, and full cost) of HIV testing facilities are searched on the Internet and confirmed through a field survey. Vulnerable populations include the uninsured and people living with HIV (PLWH), disaggregated from county-level HIV prevalence data. Spatial access is computed by a normalized urban-rural two-step floating catchment area (NUR2SFCA) method. Our survey confirms that only 11% and 37% of the 103 Internet-searched HIV testing facilities are indeed free and low-cost. Making more facilities cheaper or free increases the average access of PLWH, the uninsured, and the entire population but their geographic patterns vary. Free testing facilities, clustered in Baton Rouge city, are highly accessible to 82.6%, 69.4%, and 70.2% of three population groups living in East and West Baton Rouge Parish. In comparison, making all low-cost facilities free increases access in most outlying parishes but at the cost of reducing access in East Baton Rouge Parish, leaving west Livingston, north Iberville, and east Pointe Coupee Parish with the poorest access. Making all full-cost facilities cheaper or free exhibits a similar pattern. The study has important policy implications for where and how to improve access to HIV testing for vulnerable populations.
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Affiliation(s)
- Changzhen Wang
- Department of Geography and the Environment, University of Alabama, Tuscaloosa, AL, 35401, USA.
| | | | - Michael Leitner
- Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, 70803, USA
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Walsh JL, Quinn KG, Hirshfield S, John SA, Algiers O, Al-Shalby K, Giuca AM, McCarthy C, Petroll AE. Acceptability, Feasibility, and Preliminary Impact of 4 Remotely-Delivered Interventions for Rural Older Adults Living with HIV. AIDS Behav 2024; 28:1401-1414. [PMID: 38170275 DOI: 10.1007/s10461-023-04227-5] [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] [Accepted: 11/15/2023] [Indexed: 01/05/2024]
Abstract
People living with HIV (PLH) who live in rural areas of the United States (US) face more challenges to obtaining medical care and suffer higher mortality rates compared to non-rural PLH. Compared with younger PLH, older PLH (age 50+) also face additional challenges to maintaining their health and wellbeing. Despite the heightened barriers to receiving care and remaining adherent to treatment among older rural PLH, few interventions to increase viral suppression and improve quality of life exist for this population. We pilot-tested four remotely-delivered interventions-group-based social support, group-based stigma-reduction, individual strengths-based case management, and individual technology detailing-aimed to improve care engagement and quality of life in rural older PLH in the southern US. Participants (N = 61, Mage = 58, 75% male) completed surveys and self-collected blood specimens at baseline and 3 months; in between, they were randomized to 0-4 interventions. We assessed feasibility, acceptability, and preliminary impact on medication adherence, viral suppression, quality of life, depressive symptoms, and hypothesized mediating mechanisms. More than 80% participated in assigned intervention(s), and 84% completed the study. Interventions were highly acceptable to participants, with more than 80% reporting they would recommend interventions to peers. More than 80% found the social support and case management interventions to be relevant and enjoyable. We found promising preliminary impact of interventions on quality of life, medication adherence, depressive symptoms, internalized stigma, and loneliness. Remotely-delivered interventions targeting rural older PLH are feasible to conduct and acceptable to participants. Larger scale study of these interventions is warranted.
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Affiliation(s)
- Jennifer L Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Katherine G Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sabina Hirshfield
- STAR Program, Department of Medicine, SUNY Downstate Health Sciences University, New York, NY, USA
| | - Steven A John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Olivia Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kamal Al-Shalby
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
| | - Anne-Marie Giuca
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of Geriatric Psychiatry, Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Caitlin McCarthy
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Andrew E Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA.
- Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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Moen M, Sublette N, Alves J, Walker CM. Policy Challenges and Resiliency Related to Ending the HIV Epidemic in the Southern and Rural United States: A Call to Action. J Assoc Nurses AIDS Care 2024; 35:161-172. [PMID: 38306307 DOI: 10.1097/jnc.0000000000000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
ABSTRACT In this commentary, we describe current policy trends and their implications for the health of populations in the Southern and rural United States. We outline policy changes that threaten the prevention, care, and treatment of people at risk for HIV or with HIV and sociopolitical factors contributing to these policy trends. We also issue a call-to-action for individuals with Southern and rural US policy expertise and lived or living experience to collaboratively engage on a systematic policy analysis to thoroughly document relevant policies and deepen our understanding of the influences behind these policies. Finally, we provide examples of individual, community, and national level resiliency and courage-strategies that inspire advocacy and hope in the face of policy setbacks.
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Affiliation(s)
- Marik Moen
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Nina Sublette
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Justin Alves
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
| | - Crystal Martin Walker
- Marik Moen, PhD, MPH, RN, is an Assistant Professor, University of Maryland Baltimore School of Nursing, Baltimore, Maryland, USA
- Nina Sublette, PhD, APRN-FNP, AACRN, SANE-P, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
- Justin Alves, MSN, FNP-BC, ACRN, CARN, CNE, is a Clinical Nurse Educator with Boston Medical Center's Grayken Center for Addiction Training and Technical Assistance, Boston, Massachusetts, USA
- Crystal Martin Walker, PhD, DNP, FNP-C, is an Assistant Professor, University of Tennessee Health Sciences Center College of Nursing, Memphis, Tennessee, USA
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6
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Gibas KM, Rebeiro PF, Brantley M, Mathieson S, Maurer L, Pettit AC. Geographic disparities in late HIV diagnoses in Tennessee: Opportunities for interventions in the rural Southeast. J Rural Health 2024. [PMID: 38361431 PMCID: PMC11324855 DOI: 10.1111/jrh.12829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE Incident HIV remains an important public health issue in the US South, the region leading the nation in HIV incidence, rural HIV cases, and HIV-related deaths. Late diagnoses drive incident HIV and understanding factors driving late diagnoses is critical for developing locally relevant HIV testing and prevention interventions, decreasing HIV transmission, and ending the HIV epidemic. METHODS Retrospective cohort study utilizing Tennessee Department of Health (TDH) surveillance data and US Census Bureau data. Adults of ≥18-year old with a new HIV diagnosis between January 1, 2015 and December 31, 2019 identified in the TDH electronic HIV/AIDS Reporting System were included. Individuals were followed from initial HIV diagnosis until death, 90 days of follow-up for outcome assessment, or administrative censoring 90 days after study enrollment closed. FINDINGS We included 3652 newly HIV-diagnosed individuals; median age was 31 years (IQR: 25, 42), 2909 (79.7%) were male, 2057 (56.3%) were Black, 246 (6.7%) were Hispanic, 408 (11.2%) were residing in majority-rural areas at diagnosis, and 642 (17.6%) individuals received a late HIV diagnosis. Residents of majority-rural counties (adjusted risk ratios [aRR] = 1.39, 95% confidence intervals [CI]: 1.16-1.67) and Hispanic individuals (aRR = 1.87, 95% CI: 1.50-2.33) had an increased likelihood of receiving a late diagnosis after controlling for race/ethnicity, age, and year of HIV diagnosis. CONCLUSIONS Rural residence and Hispanic ethnicity were associated with an increased risk of receiving a late HIV diagnosis in Tennessee. Future HIV testing and prevention efforts should be adapted to the needs of these vulnerable populations.
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Affiliation(s)
- Kevin M Gibas
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Epidemiology & Infection Prevention, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Peter F Rebeiro
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- Department of Medicine and Department of Biostatistics, Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Meredith Brantley
- Section of HIV, Sexually Transmitted Infections, and Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Samantha Mathieson
- Section of HIV, Sexually Transmitted Infections, and Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Laurie Maurer
- Section of HIV, Sexually Transmitted Infections, and Viral Hepatitis, Tennessee Department of Health, Nashville, Tennessee, USA
| | - April C Pettit
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Bono RS, Pan Z, Dahman B, Deng Y, Kimmel AD. Urban-rural disparities in geographic accessibility to care for people living with HIV. AIDS Care 2023; 35:1844-1851. [PMID: 36369925 PMCID: PMC10175509 DOI: 10.1080/09540121.2022.2141186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/21/2022] [Indexed: 11/15/2022]
Abstract
In the United States, people living with HIV (PLWH) in rural areas fare worse along the HIV care continuum than their urban counterparts; this may be due in part to limited geographic access to care. We estimated drive time to care for PLWH, focusing on urban-rural differences. Adult Medicaid enrollees living with HIV and their usual care clinicians were identified using administrative claims data from 14 states (Medicaid Analytic eXtract, 2009-2012). We used geographic network analysis to calculate one-way drive time from the enrollee's ZIP code tabulation area centroid to their clinician's practice address, then examined urban-rural differences using bivariate statistics. Additional analyses included altering the definition of rurality; examining subsamples based on the state of residence, services received, and clinician specialty; and adjusting for individual and county characteristics. Across n = 49,596 PLWH, median drive time to care was 12.8 min (interquartile range 26.3). Median drive time for rural enrollees (43.6 (82.0)) was nearly four times longer than for urban enrollees (11.9 (20.6) minutes, p < 0.0001), and drive times exceeded one hour for 38% of rural enrollees (versus 12% of urban, p < 0.0001). Urban-rural disparities remained in all additional analyses. Sustained efforts to circumvent limited geographic access to care are critical for rural areas.
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Affiliation(s)
- Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Zhongzhe Pan
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Yangyang Deng
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Dumedah G, Iddrisu S, Asare C, Adu-Prah S, English S. Inequities in spatial access to health services in Ghanaian cities. Health Policy Plan 2023; 38:1166-1180. [PMID: 37728231 DOI: 10.1093/heapol/czad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/12/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023] Open
Abstract
Consideration of health equity is fundamental to enhancing the health of those who are economically/socially disadvantaged. A vital characteristic of health equity and therefore health disparity is the level of spatial access to health services and its distribution among populations. Adequate knowledge of health disparity is critical to enhancing the optimal allocation of resources, identification of underserved populations and improving the efficiency and performance of the health system. The provision of such insight for sub-Saharan African (SSA) cities is a challenge and is severely limited in the literature. Accordingly, this study examined the disparities in potential spatial access to health services for four selected urban areas in Ghana based on: (1) the number of physicians per population; (2) access score based on a weighted sum of access components; (3) travel time to health services and (4) the combined evaluation of linkages between travel distance, settlement area, population and economic status. The overall spatial access to health services is low across all selected cities varying between 3.02 and 1.78 physicians per 10 000 persons, whereas the access score is between 1.70 and 2.54. The current number of physicians needs to be increased by about five times to satisfy the World Health Organization's standard. The low spatial access is not equitable across and within the selected cities, where the economically disadvantaged populations were found to endure longer travel distances to access health services. Inequities were found to be embedded within the selected cities where economically poor populations are also disadvantaged in their physical access to healthcare. The health facilities in all cities have reasonable travel distances separating them but are inadequately resourced with physicians. Thus, increasing the physician numbers and related resources at spatially targeted existing facilities would considerably enhance spatial access to health services.
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Affiliation(s)
- Gift Dumedah
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Seidu Iddrisu
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Christabel Asare
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ashanti Region 0000, Ghana
| | - Samuel Adu-Prah
- Department of Environmental and Geosciences, Sam Houston State University, Huntsville, TX 77341, USA
| | - Sinead English
- School of Biological Sciences, University of Bristol, Bristol BS8 1QU, UK
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Dasgupta S, McManus T, Tie Y, Lin CYC, Yuan X, Sharpe JD, Fletcher KM, Beer L. Comparison of Demographic Characteristics and Social Determinants of Health Between Adults With Diagnosed HIV and All Adults in the U.S. AJPM FOCUS 2023; 2:100115. [PMID: 37790662 PMCID: PMC10546490 DOI: 10.1016/j.focus.2023.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Quantifying disparities in social determinants of health between people with HIV and the total population could help address health inequities, and ensure health and well-being among people with HIV in the U.S., but estimates are lacking. Methods Several representative data sources were used to assess differences in social determinants of health between adults with diagnosed HIV (Centers for Disease Control and Prevention Medical Monitoring Project) and the total adult population (U.S. Census Bureau's decennial census, American Community Survey, Household Pulse Survey, the Current Population Survey Annual Social and Economic Supplements; the Department of Housing and Urban Development's point-in-time estimates of homelessness; and the Bureau of Justice Statistics). The differences were quantified using standardized prevalence differences and standardized prevalence ratios, adjusting for differences in age, race/ethnicity, and birth sex between people with HIV and the total U.S. population. Results Overall, 35.6% of people with HIV were living in a household with an income at or below the federal poverty level, and 8.1% recently experienced homelessness. Additionally, 42.9% had Medicaid and 27.6% had Medicare; 39.7% were living with a disability. Over half (52.3%) lived in large central metropolitan counties and 20.6% spoke English less than very well based on survey responses. After adjustment, poverty (standardized prevalence difference=25.1%, standardized prevalence ratio=3.5), homelessness (standardized prevalence difference=8.5%, standardized prevalence ratio=43.5), coverage through Medicaid (standardized prevalence difference=29.5%, standardized prevalence ratio=3.0) or Medicare (standardized prevalence difference=7.8%), and disability (standardized prevalence difference=30.3%, standardized prevalence ratio=3.0) were higher among people with HIV than the total U.S. population. The percentage of people with HIV living in large central metropolitan counties (standardized prevalence difference=13.4%) or who were recently incarcerated (standardized prevalence ratio=5.9) was higher than the total U.S. population. Conclusions These findings provide a baseline for assessing national-level disparities in social determinants of health between people with HIV and the total U.S. population, and it can be used as a model to assess local disparities. Addressing social determinants of health is essential for achieving health equity, requiring a multipronged approach with interventions at the provider, facility, and policy levels.
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Affiliation(s)
- Sharoda Dasgupta
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tim McManus
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yunfeng Tie
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carol Yen-Chin Lin
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Yuan
- DLH Corporation, Atlanta, Georgia
| | - J. Danielle Sharpe
- Division of Global HIV and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly M. Fletcher
- DRT Strategies, Atlanta, Georgia
- Agency for Toxic Substances and Disease Registry, Geospatial Research, Analysis, and Services Program, Atlanta, Georgia
| | - Linda Beer
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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10
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Webster JL, Rafalko N, Thorpe LE, Duncan DT, Gracely EJ, Goldstein ND. Alignment of Ending the HIV Epidemic Priority Jurisdictions With Availability of HIV Service Organizations: An Ecological Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:320-331. [PMID: 37535323 DOI: 10.1521/aeap.2023.35.4.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
We sought to describe and quantify the association between HIV service organization availability, HIV burden, and HIV awareness and prevention in the 57 priority jurisdictions selected as part of the U.S. Ending the HIV Epidemic initiative. On average, jurisdictions with more per capita organizations had more people living with HIV, more individuals aware of their positive status, and more individuals prescribed PrEP (b = 0.3; 95% CI [0.2, 0.5] for each additional case per 1,000 people in the first metric, and b = 0.3; 95% CI [0.2, 0.4] and b = 0.1; 95% CI [< 0.1, 0.1], respectively, for each percentage point change in the second two metrics), accounting for jurisdiction size. Several jurisdictions were outliers in the modeled associations and may reflect comparatively better, or worse, performance than similar jurisdictions. This information can assist in evaluating resource allocation and determining whether availability translates to accessibility.
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Affiliation(s)
- Jessica L Webster
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Nicole Rafalko
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Lorna E Thorpe
- Department of Population Health, New York University Langone Health, New York, New York
| | - Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Ed J Gracely
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
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11
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Shacham E, Scroggins SE, Ellis M. Implementing Geospatial Science and Technology to Get to Zero New HIV Infections. Curr HIV/AIDS Rep 2023; 20:139-147. [PMID: 37145264 DOI: 10.1007/s11904-023-00658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Tremendous advancements have been made in HIV treatment and prevention during the last 40 years that zero new HIV cases has become an attainable goal declared by international agencies. However, new cases of HIV infection persist. RECENT FINDINGS The emerging field of geospatial science is positioned to play key role in the reduction of continued HIV incidence through technology-driven interventions and innovative research that gives insights into at-risk populations. As these methods become more utilized, findings consistently show the important role of location and environment plays in HIV incidence and treatment adherence. This includes distance to HIV provider, locations of where HIV transmissions occurs compared to where people with HIV reside, and how geospatial technology has been leveraged to identify unique insights among varying groups of those at increased risk for HIV, among others. Given these insights, leveraging geospatial technology would play a prominent role in achieving zero new cases of HIV infections.
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Affiliation(s)
- Enbal Shacham
- College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA.
- Taylor Geospatial Institute, St. Louis, MO, USA.
| | | | - Matthew Ellis
- Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO, USA
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12
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Jones MD, Dyer K, Nedell ER, Fletcher MR, Grimsley Ackerley C, Hussen SA, Kalokhe AS. One size does not fit all: Preferences for HIV care delivery among out-of-care people living with HIV in the Southeastern United States. PLoS One 2023; 18:e0276852. [PMID: 36649350 PMCID: PMC9844861 DOI: 10.1371/journal.pone.0276852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/16/2022] [Indexed: 01/18/2023] Open
Abstract
Approximately half of the people with HIV (PWH) in the United States are retained in HIV care and only 57% have achieved viral suppression, due to barriers including transportation access, stigma, poor mental health, substance use, and medical mistrust. Community-based HIV care models have potential to address the diverse needs of patients and to improve retention in care, but their success is contingent on acceptance by patients and key community stakeholders. Recognizing that the preferences of PWH who are out-of-care (PWH-OOC) likely differ from those retained in care, we conducted a mixed-methods study from June 2019 to May 2021 composed of surveys with PWH-OOC (n = 50) and in-depth interviews with key clinic and community stakeholders (n = 41) to examine the relative preference and perceived advantages and disadvantages for six different community-based HIV care models versus the traditional fixed-clinic model. Survey data was analyzed to assess average rank preference for each care model and interview transcripts were thematically coded to examine factors influencing model acceptance. The highest preference for care delivery was via a mobile clinic, followed by community-based peer navigation, primary care clinics, telemedicine, traditional HIV subspeciality clinic, homeless shelter, and drug treatment center. Common factors influencing preference included convenience, accessibility, potential to preserve confidentiality, quality of care assurance, opportunity to develop rapport with their HIV care provider, access to a smart device, and potential to alleviate versus exacerbate HIV stigma. Participants discussed need for integration of care models and for individuals to choose different care models at different times. Providers and patients differed in preference for care model and weighting of relative advantages and disadvantages of each. Findings highlight the need to integrate alternative, community-based care models into the national plan to end the HIV epidemic and to allow for PWH-OOC to choose the model most fitting based on individual circumstances.
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Affiliation(s)
- Marxavian D. Jones
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Kelly Dyer
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Emma R. Nedell
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Michelle R. Fletcher
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Cassie Grimsley Ackerley
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Sophia A. Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Ameeta S. Kalokhe
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States of America
- * E-mail:
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13
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Owens C, Voorheis E, Lester JN, Green HD, Herbenick D, Dodge B, Hubach RD. The lived experiences of rural HIV social workers. AIDS Care 2023; 35:48-52. [PMID: 34612112 DOI: 10.1080/09540121.2021.1981817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to August 2019, 15 HIV service providers participated in a one-hour semi-structured telephone interview that elicited their experiences working in the rural HIV care continuum. Participants were tired of constantly educating and working to reduce HIV stigma; however, they received support from family and friends once they educated them about HIV. Participants felt they lacked control over systems and they developed emotional-based coping to address constant occupational stressors. Findings highlight the importance of resiliency and advocacy research and practice across ecological levels.
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Affiliation(s)
- Christopher Owens
- Department of Health and Kinesiology, College of Education and Human Development, Texas A&M University, College Station, TX, USA.,Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Jessica N Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Harold D Green
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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14
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Quinn K, John S, Hirshfield S, Algiers O, O'Neil A, Petroll A, Walsh J. Challenges to meeting the HIV care needs of older adults in the rural South. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100113. [PMID: 36620181 PMCID: PMC9815493 DOI: 10.1016/j.ssmqr.2022.100113] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
People living with HIV in rural parts of the Southern United States face poor outcomes along the HIV care continuum. Additionally, over half of people with diagnosed HIV are age 50 and older. Older adults living with HIV in the rural South often have complex health and social needs associated with HIV, aging, and the rural environment. Research is needed to understand what support organizations and clinics need in providing care to this population. This qualitative study examines the challenges health and social service providers face in caring for older patients living with HIV. In 2020-2021, we interviewed 27 key informants who work in organizations that provide care to older adults with HIV in the seven states with high rural HIV burden: Alabama, Arkansas, Kentucky, Mississippi, Missouri, Oklahoma, and South Carolina. Our findings highlight how racism and poverty; culture, politics, and religion; and a lack of healthcare infrastructure collectively shape access to HIV care for older adults in the South. Rural health and social service providers need structural-level changes to improve their care and services.
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Affiliation(s)
- K.G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S.A. John
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - S. Hirshfield
- SUNY Downstate Health Sciences University, 450 Clarkson Ave., Brooklyn, NY, 11203, United States
| | - O. Algiers
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - A. O'Neil
- Institute for Health and Equity, Medical College of Wisconsin, 8701 W. Watertown Plank Road, Wauwatosa, WI, 53226, United States
| | - A.E. Petroll
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
| | - J.L. Walsh
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N. Summit Ave., Milwaukee, WI, 53202, United States
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15
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Cooper H, Reif S, Wilson E, Ward D. The COVID-19 Pandemic: Impact on Southern HIV Service Organizations, Staff, and Clients. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:333-347. [PMID: 35994575 DOI: 10.1521/aeap.2022.34.4.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The COVID-19 pandemic has exacerbated HIV-related disparities and has likely disrupted service provision by organizations providing critical HIV-related services, especially in the U.S. Deep South, an area disproportionately affected by HIV. To assess the impact of COVID-19 on organizations providing services for people living with HIV and/or sexual and gender minorities throughout the Deep South, an online survey was developed and disseminated from January to June 2021 regarding service disruption, organizational changes and needs, and staff and client impact and needs. Organizations reported ongoing organization-level financial and structural complications, staff difficulties including mental health challenges and lack of technology proficiency, and exacerbated challenges for clients including increased mental health concerns, substance use, and housing instability, among others. Organizations will need to be supported as they navigate the exacerbated mental health challenges of clients and staff as well as financially supported as they address economic disparities related to the pandemic.
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Affiliation(s)
- Haley Cooper
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina
| | - Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina
| | - Elena Wilson
- Center for Health Policy and Inequalities Research, Duke University, Durham, North Carolina
| | - Dafina Ward
- Southern AIDS Coalition, Birmingham, Alabama
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16
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Kang JY, Farkhad BF, Chan MPS, Michels A, Albarracin D, Wang S. Spatial accessibility to HIV testing, treatment, and prevention services in Illinois and Chicago, USA. PLoS One 2022; 17:e0270404. [PMID: 35895722 PMCID: PMC9328561 DOI: 10.1371/journal.pone.0270404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 06/09/2022] [Indexed: 11/25/2022] Open
Abstract
Accomplishing the goals outlined in “Ending the HIV (Human Immunodeficiency Virus) Epidemic: A Plan for America Initiative” will require properly estimating and increasing access to HIV testing, treatment, and prevention services. In this research, a computational spatial method for estimating access was applied to measure distance to services from all points of a city or state while considering the size of the population in need for services as well as both driving and public transportation. Specifically, this study employed the enhanced two-step floating catchment area (E2SFCA) method to measure spatial accessibility to HIV testing, treatment (i.e., Ryan White HIV/AIDS program), and prevention (i.e., Pre-Exposure Prophylaxis [PrEP]) services. The method considered the spatial location of MSM (Men Who have Sex with Men), PLWH (People Living with HIV), and the general adult population 15–64 depending on what HIV services the U.S. Centers for Disease Control (CDC) recommends for each group. The study delineated service- and population-specific accessibility maps, demonstrating the method’s utility by analyzing data corresponding to the city of Chicago and the state of Illinois. Findings indicated health disparities in the south and the northwest of Chicago and particular areas in Illinois, as well as unique health disparities for public transportation compared to driving. The methodology details and computer code are shared for use in research and public policy.
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Affiliation(s)
- Jeon-Young Kang
- Department of Geography Education, Kongju National University, Gongju-si, Chungcheongnam-do, South Korea
| | - Bita Fayaz Farkhad
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Man-pui Sally Chan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Alexander Michels
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
- Illinois informatics Institute, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
| | - Dolores Albarracin
- University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Shaowen Wang
- CyberGIS Center for Advanced Digital and Spatial Studies, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
- Illinois informatics Institute, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
- Department of Geography and Geographic Information Science, University of Illinois Urbana-Champaign, Urbana, Illinois, United States of America
- * E-mail:
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17
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Luo Q, Pfeiffer RM, Noone AM, Horner MJ, Engels EA, Shiels MS. Years of life lost to cancer among the United States HIV population, 2006-2015. AIDS 2022; 36:1279-1286. [PMID: 35608110 PMCID: PMC9283267 DOI: 10.1097/qad.0000000000003249] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We estimated years of life lost (YLLs) to all causes of death and YLL lost to cancer among persons with HIV (PWH) in the United States. DESIGN Linked HIV and cancer registry data from the HIV/AIDS Cancer Match Study were used to identify incident cancers and deaths among PWH in 11 regions of the United States during 2006-2015. METHODS Mean YLL (MYLL) to all causes of death and MYLL to cancer during 2006-2015 were derived from the restricted mean survival estimated from Cox proportional hazards regression models. MYLLs were then upweighted to the national population of PWH to obtain all-cause total YLL (TYLL) and cancer-related TYLL in the United Staets during 2006-2015. RESULTS Among 466 234 PWH in the study population, 25 772 (5.5%) developed cancer during 2006-2015. Nationally, an estimated 134 986 years of life were lost to cancer of all types during 2006-2015 among PWH, representing 9.6% of TYLL to all causes. Non-Hodgkin lymphoma (NHL), Kaposi sarcoma, anal cancer, and lung cancer were the four largest cancer contributors (45% of TYLL to cancer). The largest fraction of TYLL occurred among back PWH, MSM, and PWH aged 40-59 years old. CONCLUSION PWH have higher mortality rates after developing cancer. NHL, Kaposi sarcoma and anal and lung cancers were large contributors to YLL to cancer in the United States population of PWH, highlighting opportunities to reduce cancer mortality through improved access to antiretroviral treatment, prevention, and screening.
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Affiliation(s)
| | - Ruth M Pfeiffer
- Biostatistics Branch, Division of Cancer Epidemiology and Genetics
| | - Anne-Michelle Noone
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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18
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Leenen J, Wijers JNAP, Den Daas C, de Wit J, Hoebe CJPA, Dukers-Muijrers NHTM. HIV testing behaviour and associated factors in men who have sex with men by level of urbanisation: a cross-sectional study in the Netherlands. BMJ Open 2022; 12:e049175. [PMID: 35027414 PMCID: PMC8762132 DOI: 10.1136/bmjopen-2021-049175] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Regular HIV testing in men who have sex with men (MSM) enables timely entry into care and reduces the likelihood of HIV transmission. We aimed to assess HIV-testing behaviour and associated factors in MSM by urbanisation of place of residence. DESIGN Data were derived from online survey ('Men & Sexuality') in the Netherlands, which was mainly advertised on social media (Facebook and Instagram), dating websites, apps for MSM (Grindr and PlanetRomeo) and gay media. PRIMARY AND SECONDARY OUTCOME MEASURES HIV testing was defined as recent (<1 year), not recent (≥1 year) or never. Using multinominal regression analyses, factors associated with not recent testing and never testing, compared with recent testing, were assessed among MSM living in highly (>2500 residences/km2) or non-highly (≤2500 residences/km2) urbanised areas. PARTICIPANTS The study sample included 3815 MSM, currently living in the Netherlands. The mean age was 36 years (SD 14.7), and 67.6% were highly educated. RESULTS In highly urbanised areas, 11.8% was never and 19.8% was not recently HIV-tested. In non-highly urbanised areas, this was 25.2% and 19.6%. Among MSM living in highly urbanised areas, independently associated with never and not recent testing were younger age, self-identification as bisexual, fewer sex partners, never notified of HIV and no recent condomless anal intercourse. Among MSM living in non-highly urbanised areas, lower perceived HIV severity, higher perceived HIV risk and a lower proportion gay friends were associated with never and not recent testing. Among never tested MSM, those in non-highly urbanised areas preferred self-sampling/self-testing over facility-based testing; those in highly urbanised areas preferred testing at healthcare facilities. CONCLUSIONS The proportion of never tested MSM was high (25%) in non-highly urbanised areas in the Netherlands. MSM living in non-highly urbanised areas may possibly be reached with targeted approaches to increase HIV testing uptake such as self-testing/self-sampling strategies.
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Affiliation(s)
- Jeanine Leenen
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Juliën N A P Wijers
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Chantal Den Daas
- Institute of Applied Health Sciences, Health Psychology, University of Aberdeen, Aberdeen, UK
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - John de Wit
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Nicole H T M Dukers-Muijrers
- Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
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19
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Belden M, Reif S, Cooper H, Shilling S, Mouhanna F, Hipp P, Siegler A. The geographic reach of community-based organizations in addressing HIV-related stigma in the Deep South. AIDS Care 2022; 34:60-68. [PMID: 34632864 PMCID: PMC8758532 DOI: 10.1080/09540121.2021.1978379] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 08/25/2021] [Indexed: 01/03/2023]
Abstract
Community-based organizations (CBOs) have been instrumental in addressing the needs of people living with HIV, however, little is known about their efforts to address HIV-related stigma through stigma reduction efforts. This study examined practices of CBOs related to mitigating HIV-related stigma in nine Deep South states. CBOs were surveyed as part of a larger study through the Gilead COMPASS Initiative. The CBO survey asked CBO leadership about stigma in their communities and services available to address this stigma. Survey respondents (n = 207) indicated that HIV-related stigma was perceived as a substantial barrier to both HIV care and CBO services. Although just over two-thirds of survey participants reported that there were group-level programs to address HIV-related stigma, 73% reported that there were not enough interventions to meet the need in their community. Further, 68% reported a lack of individual-level stigma reduction interventions. A majority reported a lack of public media campaigns to address stigma and a lack of training available to assist CBOs to address stigma. In addition, services to address stigma were reportedly less available in rural areas compared to their urban counterparts. Study findings indicate a need to identify, implement, and scale-up effective interventions to reduce HIV stigma in the US Deep South.
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Affiliation(s)
- Micha Belden
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Susan Reif
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Haley Cooper
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Sara Shilling
- Center for Health Policy and Inequalities Research, Duke University, Durham, NC, USA
| | - Farah Mouhanna
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Palmer Hipp
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Aaron Siegler
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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20
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Dasgupta S, Tie Y, Beer L, Weiser J. Unmet needs for ancillary care services are associated with HIV clinical outcomes among adults with diagnosed HIV. AIDS Care 2021; 34:606-614. [PMID: 34180733 PMCID: PMC8712612 DOI: 10.1080/09540121.2021.1946001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ancillary care services are essential for supporting care engagement and viral suppression among persons with HIV. Estimating unmet needs for ancillary care services may help address care barriers and improve clinical outcomes, but recent, nationally representative estimates are lacking. Using CDC Medical Monitoring Project data from 2015-2018, we report representative estimates of unmet needs for ancillary care services and associations with HIV clinical outcomes among U.S. adults with HIV. Data were collected through interview and medical record abstraction. We described weighted percentages for all characteristics and associations with HIV clinical outcomes using prevalence ratios with predicted marginal means, adjusting for potential confounding. Substantial unmet needs were reported; unmet needs were higher among persons with social determinants of poor health, persons who engaged in drug use or binge drinking, and those who experienced depression or anxiety. Having unmet needs for care was associated with adverseHIV clinical outcomes, with a dose response effect between number of unmet needs and outcomes. Expanding ancillary care access based on a comprehensive care model, strengthening partnerships between providers to connect patients to essential services, and tailoring services based on need may help reduce disparities in unmet needs and improve outcomes.
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Affiliation(s)
- Sharoda Dasgupta
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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21
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Bono RS, Dahman B, Sabik LM, Yerkes LE, Deng Y, Belgrave FZ, Nixon DE, Rhodes AG, Kimmel AD. Human Immunodeficiency Virus-Experienced Clinician Workforce Capacity: Urban-Rural Disparities in the Southern United States. Clin Infect Dis 2021; 72:1615-1622. [PMID: 32211757 DOI: 10.1093/cid/ciaa300] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/23/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)-experienced clinicians are critical for positive outcomes along the HIV care continuum. However, access to HIV-experienced clinicians may be limited, particularly in nonmetropolitan areas, where HIV is increasing. We examined HIV clinician workforce capacity, focusing on HIV experience and urban-rural differences, in the Southern United States. METHODS We used Medicaid claims and clinician characteristics (Medicaid Analytic eXtract [MAX] and MAX Provider Characteristics, 2009-2011), county-level rurality (National Center for Health Statistics, 2013), and diagnosed HIV cases (AIDSVu, 2014) to assess HIV clinician capacity in 14 states. We assumed that clinicians accepting Medicaid approximated the region's HIV workforce, since three-quarters of clinicians accept Medicaid insurance. HIV-experienced clinicians were defined as those providing care to ≥ 10 Medicaid enrollees over 3 years. We assessed HIV workforce capacity with county-level clinician-to-population ratios, using Wilcoxon-Mann-Whitney tests to compare urban-rural differences. RESULTS We identified 5012 clinicians providing routine HIV management, of whom 28% were HIV-experienced. HIV-experienced clinicians were more likely to specialize in infectious diseases (48% vs 6%, P < .001) and practice in urban areas (96% vs 83%, P < .001) compared to non-HIV-experienced clinicians. The median clinician-to-population ratio for all HIV clinicians was 13.3 (interquartile range, 38.0), with no significant urban-rural differences. When considering HIV experience, 81% of counties had no HIV-experienced clinicians, and rural counties generally had fewer HIV-experienced clinicians per 1000 diagnosed HIV cases (P < .001). CONCLUSIONS Significant urban-rural disparities exist in HIV-experienced workforce capacity for communities in the Southern United States. Policies to improve equity in access to HIV-experienced clinical care for both urban and rural communities are urgently needed.
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Affiliation(s)
- Rose S Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren E Yerkes
- Division of Population Health Data, Virginia Department of Health, Richmond, Virginia, USA.,Division of Disease Prevention, Virginia Department of Health, Richmond, Virginia, USA
| | - Yangyang Deng
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Faye Z Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Daniel E Nixon
- Department of Internal Medicine, Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Anne G Rhodes
- Division of Disease Prevention, Virginia Department of Health, Richmond, Virginia, USA
| | - April D Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
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Koshy M, Mische L, Rizza S, Mahmood M, Bedimo R, Bhatia R, El Atrouni W, Curran J, Temesgen Z. Point-of-care program in HIV, tuberculosis, and associated conditions: A virtual global technical assistance platform to strengthen HIV and tuberculosis workforce capacity. J Clin Tuberc Other Mycobact Dis 2021; 23:100238. [PMID: 33997312 PMCID: PMC8102617 DOI: 10.1016/j.jctube.2021.100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A global multi-disciplinary faculty was established to work collaboratively and provide virtual technical assistance, using a point-of-care continuing education model, to clinicians across the world engaged in the care of patients with either HIV infection or tuberculosis. Ancillary offerings included live or virtual lectures, case-based conferences, and courses. In spite of the considerable disruption of the program due to the COVID-19 pandemic, we engaged and assisted a substantial number of clinicians across the world and provided meaningful contributions to their continuous professional development and patient care. In light of the ongoing pandemic, virtual technical assistance models such as this should be scaled to continue essential high-quality HIV/TB services.
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Affiliation(s)
- Maria Koshy
- Internal Medicine, Bridgeport Hospital, Yale New Haven Health, CT, USA
| | | | - Stacey Rizza
- Mayo Clinic Center for Tuberculosis, Mayo Clinic HIV Program, Division of Infectious Diseases, Mayo Clinic, USA
| | - Maryam Mahmood
- Mayo Clinic Center for Tuberculosis, Mayo Clinic HIV Program, Division of Infectious Diseases, Mayo Clinic, USA
| | - Roger Bedimo
- VA North Texas Health Care System and University of Texas Southwestern Medical Center, USA
| | - Ramona Bhatia
- Department of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
| | - Wissam El Atrouni
- The University of Kansas School of Medicine, Division of Infectious Diseases, Kansas City, KS, USA
| | - Jennifer Curran
- Mayo Clinic School of Continuous Professional Development, USA
| | - Zelalem Temesgen
- Mayo Clinic Center for Tuberculosis, Mayo Clinic HIV Program, Division of Infectious Diseases, Mayo Clinic, USA
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23
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McClarty LM, Blanchard JF, Becker ML. Leaving no one behind? An equity analysis of the HIV care cascade among a cohort of people living with HIV in Manitoba, Canada. BMC Public Health 2021; 21:281. [PMID: 33541302 PMCID: PMC7860173 DOI: 10.1186/s12889-021-10225-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background Manitoba is a central Canadian province with annual rates of new HIV infections consistently higher than the Canadian average. National surveillance statistics and data from the provincial HIV care program suggest that epidemiological heterogeneity exists across Manitoba. New HIV cases are disproportionately reported among females, Indigenous-identifying individuals, and those with a history of injection drug use. Given the heterogeneity in acquisition, it is of interest to understand whether this translates into inequalities in HIV care across Manitoba. Methods A sample of 703 participants from a clinical cohort of people living with HIV in Manitoba, with data current to the end of 2017, was used to conduct cross-sectional, disaggregated analyses of the HIV care cascade to identify heterogeneity in service coverage and clinical outcomes among different groups receiving HIV care in Manitoba. Equiplots are used to identify and visualize inequalities across the cascade. Exploratory multivariable logistic regression models quantify associations between equity variables (age, sex, geography, ethnicity, immigration status, exposure category) and progression along the cascade. Adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) are reported. Results Equity analyses highlight inequalities in engagement in and coverage of HIV-related health services among cohort participants. Equiplots illustrate that the proportion of participants in each cascade step is greater for those who are older, white, non-immigrants, and report no history of injection drug use. Compared to those living in Winnipeg, participants in eastern Manitoba have greater odds of achieving virologic suppression (AOR[95%CI] = 3.8[1.3–11.2]). The odds of Indigenous participants being virologically suppressed is half that of white participants (AOR[95%CI] = 0.5[0.3–0.7]), whereas African/Caribbean/Black participants are significantly less likely than white participants to be in care and retained in care (AOR[95%CI] = 0.3[0.2–0.7] and 0.4[0.2–0.9], respectively). Conclusions Inequalities exist across the cascade for different groups of Manitobans living with HIV; equiplots are an innovative method for visualizing these inequalities. Alongside future research aiming to understand why inequalities exist across the cascade in Manitoba, our equity analyses can generate hypotheses and provide evidence to inform patient-centred care plans that meet the needs of diverse client subgroups and advocate for policy changes that facilitate more equitable HIV care across the province.
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Affiliation(s)
- Leigh M McClarty
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R065 Medical Rehabilitation Building, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada.
| | - James F Blanchard
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R065 Medical Rehabilitation Building, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
| | - Marissa L Becker
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R065 Medical Rehabilitation Building, 771 McDermot Ave, Winnipeg, MB, R3E 0T6, Canada
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24
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Abu-Khalaf S, Dent J, Teti M, Dandachi D. Are We Prescribing Enough HIV Pre-Exposure Prophylaxis in Missouri?: A Cross-Sectional Study at University of Missouri Health Care. MISSOURI MEDICINE 2020; 117:563-568. [PMID: 33311790 PMCID: PMC7721420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite the proven efficacy and safety of HIV pre-exposure prophylaxis (PrEP), it remains underutilized. PrEP use among Missouri providers has increased as the rate of new HIV infections grows statewide, but remains lower than the Midwest and United States (U.S.) averages. Because the Centers for Disease Control and Prevention (CDC) identify Missouri as at-risk for an HIV outbreak, we seek to characterize HIV testing practices and PrEP knowledge and use among Missouri healthcare providers.
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Affiliation(s)
- Suha Abu-Khalaf
- Resident in the Department of Medicine, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - James Dent
- Division of Infectious Diseases, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Michelle Teti
- Department of Public Health, University of Missouri-Columbia School of Medicine, Columbia, Missouri
| | - Dima Dandachi
- Division of Infectious Diseases, University of Missouri-Columbia School of Medicine, Columbia, Missouri
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25
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McManus KA, Ferey J, Farrell E, Dillingham R. National Survey of US HIV Clinicians: Knowledge and Attitudes About the Affordable Care Act and Opinions of its Impact on Quality of Care and Barriers to Care. Open Forum Infect Dis 2020; 7:ofaa225. [PMID: 32665960 PMCID: PMC7336569 DOI: 10.1093/ofid/ofaa225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background The Affordable Care Act’s (ACA’s) major reforms started in 2014. In addition to assessing HIV clinicians’ ACA knowledge and attitudes, this study aims to evaluate HIV clinicians’ perspectives on whether the ACA has impacted the quality of HIV care and whether it addresses the main barriers to HIV care. Methods HIV clinicians were emailed a survey weblink in 2018. Descriptive statistics, Mann-Whitney U tests, and binary logistic regression were performed. Results Of the 211 survey participants, the majority (70%) answered all 4 knowledge questions correctly. About 80% knew correctly whether their state had expanded Medicaid. Participants from Medicaid expansion states were more likely to report an improved ability to provide high-quality care compared with participants from Medicaid nonexpansion states (50% vs 34%; P = .01). The average response to whether the ACA addresses the main barriers to HIV care was neutral and did not differ based on Medicaid status. The top 3 main barriers to HIV care cited were mental health, substance use, and transportation. Conclusions HIV clinicians in Medicaid expansion states were more likely to report an improved ability to provide high-quality care since ACA implementation compared with those in Medicaid nonexpansion states. However, HIV clinicians across the United States are concerned that the ACA does not address the main barriers to HIV care. To be successful, the “Ending the HIV Epidemic” initiative should address these identified barriers.
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Affiliation(s)
- Kathleen A McManus
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA.,Center for Health Policy, University of Virginia, Charlottesville, Virginia, USA
| | - Joshua Ferey
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Elizabeth Farrell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Rebecca Dillingham
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
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