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Trepka MJ, Dawit R, Fernandez SB, Sheehan DM, Degarege A, PhD TL, Maddox LM, Spencer EC. Social disorganization and new HIV diagnoses, 2013-2017, Florida: Rural-urban differences. J Rural Health 2022; 38:960-969. [PMID: 34861068 PMCID: PMC9163207 DOI: 10.1111/jrh.12636] [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: 11/29/2022]
Abstract
PURPOSE To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability. METHODS Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed. FINDINGS The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01). CONCLUSIONS In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St, AHC 5, Miami, Florida, USA
| | - Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tan Li PhD
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Lorene M. Maddox
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
| | - Emma C. Spencer
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
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Cha S, Adams M, Wejnert C. Intimate partner violence, HIV-risk behaviors, and HIV screening among heterosexually active persons at increased risk for infection. AIDS Care 2022; 35:867-875. [PMID: 35467983 DOI: 10.1080/09540121.2022.2067311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTIntimate partner violence (IPV) can increase a person's risk of HIV and other sexually transmitted infections (STIs), and may affect access to sexual health services. We assessed the prevalence of HIV screening and IPV among heterosexually-active persons using data from the 2016 National HIV Behavioral Surveillance. Participants were eligible if they were 18-60 years old, could complete the interview in English or Spanish, and reported having sex with an opposite sex partner in the previous 12 months. People who reported neither injection drug use within the past 12 months nor prior HIV diagnosis, and persons with valid responses to questions regarding HIV screening and physical/sexual IPV within the past 12 months were included (N = 7,777). Overall, 17% reported IPV in the previous 12 months and 19% had never had HIV screening. Abused persons were more likely to have been screened for HIV and to report high risk behaviors than non-abused persons. There was no difference in the proportion being offered HIV screening by their health care provider in the previous year. Findings suggest an integrated approach to violence prevention and sexual health may help increase awareness about clinical best practices and reduce risk for HIV/STIs among at-risk communities.
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Affiliation(s)
- Susan Cha
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Adams
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cyprian Wejnert
- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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- Behavioral and Clinical Surveillance Branch, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Zeng C, Zhang J, Sun X, Li Z, Weissman S, Olatosi B, Li X. County-level predictors of retention in care status among people living with HIV in South Carolina from 2010 to 2016: a data-driven approach. AIDS 2021; 35:S53-S64. [PMID: 33867489 PMCID: PMC8098716 DOI: 10.1097/qad.0000000000002832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the geospatial variation of retention in care (RIC) across the counties in South Carolina (SC) from 2010 to 2016 and identify the relevant county-level predictors. DESIGN Aggregated data on county-level RIC among HIV patients from 2010 to 2016 were retrieved from an electronic HIV/AIDS reporting system in SC Department of Health and Environmental Control. Sociological framework of health was used to select potential county-level predictors from multiple public datasets. METHODS Geospatial mapping was used to display the spatial heterogeneity of county-level RIC rate in SC. Generalized linear mixed effect regression with least absolute shrinkage and selection operator (LASSO) was employed to identify county-level predictors related to the change of RIC status over time. Confusion matrix and area under the curve statistics were used to evaluate model performance. RESULTS More than half of the counties had their RIC rates lower than the national average. The change of county-level RIC rate from 2010 to 2016 was not significant, and spatial heterogeneity in RIC rate was identified. A total of 22 of the 31 county-level predictors were selected by LASSO for predicting county-level RIC status. Counties with lower collective efficacy, larger proportions of men and/or persons with high education were more likely to have their RIC rates lower than the national average. In contrast, numbers of accessible mental health centres were positively related to county-level RIC status. CONCLUSION Spatial variation in RIC could be identified, and county-level factors associated with accessible healthcare facilities and social capital significantly contributed to these variations. Structural and individual interventions targeting these factors are needed to improve the county-level RIC and reduce the spatial variation in HIV care.
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Affiliation(s)
- Chengbo Zeng
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- University of South Carolina Big Data Health Science Center
| | - Jiajia Zhang
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- University of South Carolina Big Data Health Science Center
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
| | - Xiaowen Sun
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- University of South Carolina Big Data Health Science Center
- Department of Epidemiology and Biostatistics, Arnold School of Public Health
| | - Zhenlong Li
- University of South Carolina Big Data Health Science Center
- Geoinformation and Big Data Research Lab, Department of Geography, College of Arts and Sciences
| | - Sharon Weissman
- University of South Carolina Big Data Health Science Center
- School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Bankole Olatosi
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- University of South Carolina Big Data Health Science Center
- Department of Health Services, Policy, and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- South Carolina SmartState Center for Healthcare Quality, University of South Carolina
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina
- University of South Carolina Big Data Health Science Center
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Urban K, Chu S, Giesey RL, Mehrmal S, Uppal P, Delost ME, Delost GR. Burden of skin disease and associated socioeconomic status in Asia: A cross-sectional analysis from the Global Burden of Disease Study 1990-2017. JAAD Int 2020; 2:40-50. [PMID: 34409353 PMCID: PMC8362322 DOI: 10.1016/j.jdin.2020.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2020] [Indexed: 01/22/2023] Open
Abstract
Introduction Skin diseases have a significant global impact on quality of life, mental health, and loss of income. The burden of dermatologic conditions and its relationship with socioeconomic status in Asia is currently not well understood. Methods We selected Global Burden of Disease Study datasets to analyze disability-adjusted life years (DALYs) in 50 Asian countries, including Central Asia, northern Asia, eastern Asia, western Asia, southeastern Asia, and southern Asia, between 1990 and 2017. We compared DALYs to the socioeconomic status using the sociodemographic index and gross domestic product per capita of a country. Statistical analysis was performed using Pearson's correlation. Results Some countries had higher or lower than expected age-standardized DALY rates of skin diseases. Asian countries, especially high-income countries, had a high burden of inflammatory dermatoses, including acne, alopecia areata, atopic dermatitis, contact dermatitis, decubitus ulcers, psoriasis, pruritus, and seborrheic dermatitis. The burden of infectious dermatoses was greater in low-income Asian countries. The burden of skin cancer in Asia was relatively low. Conclusion There is a high burden of skin disease, especially inflammatory conditions, in Asian countries, but the burden of individual dermatoses in Asia varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Asia.
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Affiliation(s)
- Katelyn Urban
- Lake Erie College of Osteopathic Medicine, Greensburg, Pennsylvania
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
| | - Rachel L Giesey
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Sino Mehrmal
- Department of Internal Medicine, Alameda Health System - Highland Hospital, Oakland, California
| | - Prabhdeep Uppal
- Department of Emergency Medicine, Christiana Care Health System, Newark, Delaware.,Department of Family Medicine, Christiana Care Health System, Newark, Delaware
| | - Maria E Delost
- Department of Health Professions, Youngstown State University, Youngstown, Ohio
| | - Gregory R Delost
- Apex Dermatology and Skin Surgery Center, Mayfield Heights, Mayfield Heights, Ohio.,Lake Erie College of Osteopathic Medicine, Eerie, Pennsylvania
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Xiao Y. Predicting spatial and temporal responses to non-pharmaceutical interventions on COVID-19 growth rates across 58 counties in New York State: A prospective event-based modeling study on county-level sociological predictors. JMIR Public Health Surveill 2020. [PMID: 33207309 DOI: 10.2196/22578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Non-pharmaceutical interventions (NPIs) have been implemented in the New York State since the COVID-19 outbreak on March 1, 2020 to control the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Socioeconomic heterogeneity across counties closely manifests differences in the post-NPIs growth rate of incidence, which is a crucial indicator to guide future infectious control policy making. Few studies, however, examined the geospatial and sociological variations in the epidemic growth across different time points of NPIs. OBJECTIVE To guide a more effective reopening plan while controlling the transmission, the current study aims at 1) identifying hotspots of the growth rate of COVID-19 incidence among the 57 counties and New York City in NYS over time, and 2) examining the association of COVID-19 growth rates after eight critical NPIs time points and most relevant county-level sociological predictors. METHODS County-level COVID-19 incidence rates were retrieved from the Social Explorer Website between March 7, 2020 to June 22, 2020. 5-day moving average growth rates of COVID-19 incidence were calculated for 16 selected time points, including the dates of eight NPIs and their respective 14-day-lag-behind time points. A total of 36 county-level indicators were extracted from multiple public datasets. Geospatial mapping and heatmap were used to analyze spatial and temporal heterogeneity of county-level COVID-19 outbreak over selected NPIs-related dates. Generalized mixed effect least absolute shrinkage and selection operator (LASSO) regression, controlling for the 5-day moving average growth rates of COVID-19 testing rates, was employed to identify significant county-level predictors related to the changes of county-level COVID-19 growth rates over time. RESULTS COVID-19 infection increased and peaked by the end of March (η=22.50%). Growth rates of COVID-19 decreased by 50.48% after implementing NPIs such as closures of schools, non-essential businesses, parks, and subways. There was a geospatial shift in the region with the highest growth rates from New York metropolitan area towards Western and Northern regions over time. Proportions of population aged 45 years and above (β=3.25 [0.17-6.32]), living alone at residential houses (β=3.31 [0.39--6.22]), and proportion of crowd residential houses (β=6.15 [2.15-10.14]) were positively associated with the growth rate of COVID-19 infection. In contrast, living alone at rental houses (β=-2.47 [-4.83--0.12]) and rate of mental health providers (β=-1.11 [-1.95--0.28]) were negatively associated with COVID-19 growth rate across all 16 time points. CONCLUSIONS There are geospatial differences in COVID-19 incidence after implementing different NPIs. Socioeconomic, racial/ethnic, and healthcare resource disparities at the structural and historical levels across counties need to be considered in infection control policymaking to narrow the unequal health impact on vulnerable populations effectively. CLINICALTRIAL
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Affiliation(s)
- Yunyu Xiao
- School of Social Work, Indiana University-Purdue University Indianapolis, 902 W. New York StreetEducation/Social Work Building, ES 4119, Indianapolis, US
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6
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Özdemir HÖ, Tosun S, Kabadurmuş FNK, Özdemir D. The impact of socioeconomic factors on the healthcare costs of people living with HIV in Turkey. BMC Public Health 2020; 20:368. [PMID: 32197598 PMCID: PMC7082973 DOI: 10.1186/s12889-020-08469-z] [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: 11/14/2019] [Accepted: 03/05/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study addresses an important field within HIV research, the impact of socioeconomic factors on the healthcare costs of people living with HIV/AIDS (PLHIV). We aimed to understand how different socioeconomic factors could create diverse healthcare costs for PLHIV in Turkey. Methods Data were collected between January 2017 and December 2017. HIV-positive people attending the clinic who had been referred to the national ART programme from January 1992 until December 2017 were surveyed. The questionnaire collected socioeconomic data. The cost data for the same patients was taken from the electronic database Probel Hospital Information Management System (PHIMS) for the same period. The PHIMS data include costs for medication (highly active antiretroviral therapy or HAART), laboratory, pathology, radiology, polyclinic, examination and consultation, hospitalisation, surgery and intervention, blood and blood products, supplies and other costs. Data were analysed using STATA 14.2 to estimate the generalised linear model (GLM). Results The findings of our GLM indicate that age, gender, marital and parental status, time since diagnosis, employment, wealth status, illicit drug use and CD4 cell count are the factors significantly related to the healthcare cost of patients. We found that compared with people who have AIDS (CD4 cells < 200 cells/mm3), people who have a normal range of CD4 cells (≥ 500 cells/mm3) have $1046 less in expenditures on average. Compared to younger people (19–39 years), older people (≥ 55) have $1934 higher expenditures on average. Costs are $644 higher on average for married people and $401 higher on average for people who have children. Healthcare costs are $518 and $651 higher on average for patients who are addicted to drugs and who use psychiatric drug(s), respectively. Compared to people who were recently diagnosed with HIV, people who were diagnosed ≥10 years ago have $743 lower expenditures on average. Conclusion Our results suggest that in addition to immunological status, socioeconomic factors play a substantial role in the healthcare costs of PLHIV. The key factors influencing the healthcare costs of PLHIV are also critical for public policy makers, healthcare workers, health ministries and employment community programs.
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Affiliation(s)
- Hülya Özkan Özdemir
- Department of Clinical Microbiology and Infectious Diseases, University of Health Sciences, Bozyaka Education and Research Hospital, İzmir, Turkey
| | - Selma Tosun
- Department of Clinical Microbiology and Infectious Diseases, University of Health Sciences, Bozyaka Education and Research Hospital, İzmir, Turkey
| | | | - Durmuş Özdemir
- Department of Economics, Yaşar University, Üniversite Caddesi No: 37-39, 35040 Bornova, İzmir, Turkey.
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Niyonsenga T, Carroll SJ, Coffee NT, Taylor AW, Daniel M. Are changes in depressive symptoms, general health and residential area socio-economic status associated with trajectories of waist circumference and body mass index? PLoS One 2020; 15:e0227029. [PMID: 31914169 PMCID: PMC6948738 DOI: 10.1371/journal.pone.0227029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/11/2019] [Indexed: 11/18/2022] Open
Abstract
Objective This study sought to assess whether changes in depressive symptoms, general health, and area-level socio-economic status (SES) were associated to changes over time in waist circumference and body mass index (BMI). Methods A total of 2871 adults (18 years or older), living in Adelaide (South Australia), were observed across three waves of data collection spanning ten years, with clinical measures of waist circumference, height and weight. Participants completed the Centre for Epidemiologic Studies Depression (CES-D) and Short Form 36 health questionnaires (SF-36 general health domain). An area-level SES measure, relative location factor, was derived from hedonic regression models using residential property features but blind to location. Growth curve models with latent variables were fitted to data. Results Waist circumference, BMI and depressive symptoms increased over time. General health and relative location factor decreased. Worsening general health and depressive symptoms predicted worsening waist circumference and BMI trajectories in covariate-adjusted models. Diminishing relative location factor was negatively associated with waist circumference and BMI trajectories in unadjusted models only. Conclusions Worsening depressive symptoms and general health predict increasing adiposity and suggest the development of unhealthful adiposity might be prevented by attention to negative changes in mental health and overall general health.
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Affiliation(s)
- Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
- * E-mail:
| | - Suzanne J. Carroll
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
| | - Neil T. Coffee
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
- School of Architecture and Built Environment, Healthy Cities Research Group, The University of Adelaide, South Australia, Australia
| | - Anne W. Taylor
- Discipline of Medicine, The University of Adelaide, South Australia, Australia
| | - Mark Daniel
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australia
- Department of Medicine, St Vincent’s Hospital, The University of Melbourne, Fitzroy, Australia
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Gebrezgi MT, Sheehan DM, Mauck DE, Fennie KP, Ibanez GE, Spencer EC, Maddox LM, Trepka MJ. Individual and neighborhood predictors of retention in care and viral suppression among Florida youth (aged 13-24) living with HIV in 2015. Int J STD AIDS 2019; 30:1095-1104. [PMID: 31551004 DOI: 10.1177/0956462419857302] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Youth aged 13‒24 are less likely to be retained in HIV care and be virally suppressed than older age groups. This study aimed to assess predictors of retention in HIV care and viral suppression among a population-based cohort of youth (N = 2872) diagnosed with HIV between 1993 and 2014 in Florida. We used generalized estimating equations to estimate prevalence ratios (PRs). Retention in care was defined as evidence of engagement in care (at least one laboratory test, physician visit, or antiretroviral therapy prescription refill), two or more times, at least three months apart during 2015. Viral suppression was defined as having evidence of a viral load <200 copies/ml among those in care during 2015. Among the 2872 youth, 65.4% were retained in care, and among those in care, 65.0% were virally suppressed. Older youth (18‒24 years old) and non-Hispanic Blacks (NHBs) were less likely to be retained in care, whereas those men who have sex with men, perinatal HIV transmission, living in low socioeconomic neighborhoods, and those diagnosed with AIDS before 2016 were more likely to be retained in care. Those diagnosed with AIDS before 2016 and NHBs were less likely to be virally suppressed, whereas those men who have sex with men and foreign-born persons were more likely to be virally suppressed. Results suggest the need for targeted retention and viral suppression interventions for NHB youth and older youth (18‒24 years-age).
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Affiliation(s)
- Merhawi T Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA
| | - Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Gladys E Ibanez
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Emma C Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary J Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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Mauck DE, Sheehan DM, Fennie KP, Maddox LM, Trepka MJ. Role of Gay Neighborhood Status and Other Neighborhood Factors in Racial/Ethnic Disparities in Retention in Care and Viral Load Suppression Among Men Who Have Sex with Men, Florida, 2015. AIDS Behav 2018; 22:2978-2993. [PMID: 29372456 PMCID: PMC6060015 DOI: 10.1007/s10461-018-2032-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study's objective was to examine the role of gay neighborhood residence and other neighborhood factors in racial/ethnic disparities in retention in HIV care and viral load suppression during 2015. Florida residents diagnosed 2000-2014 with HIV infection and with transmission mode of men who have sex with men (MSM) were included in multi-level logistic regression models. Of 29,156 MSM, 29.4% were not retained and 34.2% were not virally suppressed. Non-Hispanic Blacks (NHB) had a higher likelihood of not being retained (adjusted prevalence ratio [aPR] 1.31, 95% confidence interval [CI] 1.24-1.38, p value < 0.0001) and not being virally suppressed (aPR 1.82, 95% CI 1.67-1.98, p value < 0.0001) compared with non-Hispanic Whites. Among NHBs, rural residence was protective for both outcomes. Although gay neighborhood residence was not associated with either outcome, the role of other neighborhood factors suggests that individual and neighborhood barriers to HIV care and treatment should be addressed among MSM.
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Affiliation(s)
- Daniel E Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Diana M Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, Miami, FL, USA
| | - Kristopher P Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
| | - Lorene M Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL, USA
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
- Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, AHC 5, Room 487, Miami, FL, 33199, USA.
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Rumbwere Dube BN, Marshall TP, Ryan RP, Omonijo M. Predictors of human immunodeficiency virus (HIV) infection in primary care among adults living in developed countries: a systematic review. Syst Rev 2018; 7:82. [PMID: 29859533 PMCID: PMC5985063 DOI: 10.1186/s13643-018-0744-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/11/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Early diagnosis of human immunodeficiency virus (HIV) is important because antiretroviral therapies are more effective if infected individuals are diagnosed early. Diagnosis of HIV relies on laboratory testing and determining the demographic and clinical characteristics of undiagnosed HIV-infected patients may be useful in identifying patients for testing. This systematic review aims to identify characteristics of HIV-infected adults prior to diagnosis that could be used in a prediction model for early detection of patients for HIV testing in UK primary care. METHODS The population of interest was adults aged ≥ 18 years in developed countries. The exposures were demographic, socio-economic or clinical characteristics associated with the outcome, laboratory confirmed HIV/AIDS infection. Observational studies with a comparator group were included in the systematic review. Electronic searches for articles from January 1995 to April 2016 were conducted on online databases of EMBASE, MEDLINE, The Cochrane Library and grey literature. Two reviewers selected studies for inclusion. A checklist was developed for quality assessment, and a data extraction form was created to collate data from selected studies. RESULTS Full-text screening of 429 articles identified 17 cohort and case-control studies, from 26,819 retrieved articles. Demographic and socio-economic characteristics associated with HIV infection included age, gender and measures of deprivation. Lifestyle choices identified were drug use, binge-drinking, number of lifetime partners and having a partner with risky behaviour. Eighteen clinical features and comorbid conditions identified in this systematic review are included in the 51 conditions listed in the British HIV Association guidelines. Additional clinical features and comorbid conditions identified but not specified in the guidelines included hyperlipidemia, hypertension, minor trauma and diabetes. CONCLUSION This systematic review consolidates existing scientific evidence on characteristics of HIV-infected individuals that could be used to inform decision making in prognostic model development. Further exploration of availability of some of the demographic and behavioural predictors of HIV, such as ethnicity, number of lifetime partners and partner characteristics, in primary care records will be required to determine whether they can be applied in the prediction model.
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Affiliation(s)
| | - Tom P. Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Ronan P. Ryan
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT UK
| | - Modupe Omonijo
- Public Health England, Health and Wellbeing Directorate, London, UK
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Sheehan DM, Cosner C, Fennie KP, Gebrezgi MT, Cyrus E, Maddox LM, Levison JH, Spencer EC, Niyonsenga T, Trepka MJ. Role of Country of Birth, Testing Site, and Neighborhood Characteristics on Nonlinkage to HIV Care Among Latinos. AIDS Patient Care STDS 2018; 32:165-173. [PMID: 29630853 DOI: 10.1089/apc.2018.0021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The objective of this study was to estimate disparities in linkage to human immunodeficiency virus (HIV) care among Latinos by country/region of birth, HIV testing site, and neighborhood characteristics. A retrospective study was conducted using Florida HIV surveillance records of Latinos/Hispanics aged ≥13 diagnosed during 2014-2015. Linkage to HIV care was defined as a laboratory test (HIV viral load or CD4) within 3 months of HIV diagnosis. Multi-level Poisson regression models were used to estimate adjusted prevalence ratios (aPR) for nonlinkage to care. Of 2659 Latinos, 18.8% were not linked to care within 3 months. Compared with Latinos born in mainland United States, those born in Cuba [aPR 0.60, 95% confidence interval (CI) 0.47-0.76] and Puerto Rico (aPR 0.61, 95% CI 0.41-0.90) had a decreased prevalence of nonlinkage. Latinos diagnosed at blood banks (aPR 2.34, 95% CI 1.75-3.12), HIV case management and screening facilities (aPR 1.76, 95% CI 1.46-2.14), and hospitals (aPR 1.42, 95% CI 1.03-1.96) had an increased prevalence of nonlinkage compared with outpatient general, infectious disease, and tuberculosis/sexually transmitted diseases/family planning clinics. Latinos who resided in the lowest (aPR 1.57, 95% CI 1.19-2.07) and third lowest (aPR 1.33, 95% CI 1.01-1.76) quartiles of neighborhood socioeconomic status compared with the highest quartile were at increased prevalence. Latinos who resided in neighborhoods with <25% Latinos also had increased prevalence of nonlinkage (aPR 1.23, 95% CI 1.01-1.51). Testing site at diagnosis may be an important determinant of HIV care linkage among Latinos due to neighborhood or individual-level resources that determine location of HIV testing.
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Affiliation(s)
- Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, Florida
| | - Chelsea Cosner
- Herbert Wertheim College of Medicine, Florida International University, Miami Florida
| | - Kristopher P. Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Merhawi T. Gebrezgi
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Elena Cyrus
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, Florida
| | - Lorene M. Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, Florida
| | - Julie H. Levison
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emma C. Spencer
- HIV/AIDS Section, Florida Department of Health, Tallahassee, Florida
| | | | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
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Kalichman S, Katner H, Banas E, Kalichman M. Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:517-525. [PMID: 28190136 DOI: 10.1007/s11121-017-0761-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIDS stigmas delay HIV diagnosis, interfere with health care, and contribute to mental health problems among people living with HIV. While there are few studies of the geographical distribution of AIDS stigma, research suggests that AIDS stigmas are differentially experienced in rural and urban areas. We conducted computerized interviews with 696 men and women living with HIV in 113 different zip code areas that were classified as large-urban, small-urban, and rural areas in a southeast US state with high-HIV prevalence. Analyses conducted at the individual level (N = 696) accounting for clustering at the zip code level showed that internalized AIDS-related stigma (e.g., the sense of being inferior to others because of HIV) was experienced with greater magnitude in less densely populated communities. Multilevel models indicated that after adjusting for potential confounding factors, rural communities reported greater internalized AIDS-related stigma compared to large-urban areas and that small-urban areas indicated greater experiences of enacted stigma (e.g., discrimination) than large-urban areas. The associations between anticipated AIDS-related stigma (e.g., expecting discrimination) and population density at the community-level were not significant. Results suggest that people living in rural and small-urban settings experience greater AIDS-related internalized and enacted stigma than their counterparts living in large-urban centers. Research is needed to determine whether low-density population areas contribute to or are sought out by people who experienced greater AIDS-related stigma. Regardless of causal directions, interventions are needed to address AIDS-related stigma, especially among people in sparsely populated areas with limited resources.
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Affiliation(s)
- Seth Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
| | | | - Ellen Banas
- Mercer University Medical School, Macon, GA, USA
| | - Moira Kalichman
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA
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13
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Cyrus E, Sheehan DM, Fennie K, Sanchez M, Dawson CT, Cameron M, Maddox L, Trepka MJ. Delayed Diagnosis of HIV among Non-Latino Black Caribbean Immigrants in Florida 2000-2014. J Health Care Poor Underserved 2018; 29:266-283. [PMID: 29503300 PMCID: PMC6446079 DOI: 10.1353/hpu.2018.0019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Prompt HIV diagnosis decreases the risk of HIV transmission and improves health outcomes. The study objective was to examine rates of delayed HIV diagnosis among non-Latino Black Caribbean immigrants in Florida. The sample included 39,008 Black HIV-positive individuals, aged 13 or older from the Caribbean and the mainland U.S. Delayed HIV diagnosis was defined as AIDS diagnosis within three months of HIV diagnosis. After adjusting for demographic factors, year of HIV diagnosis, transmission mode, neighborhood level socioeconomic status, and rural-urban residence, a disparity persisted for Caribbean-born Blacks in the Bahamas and Haiti compared with U.S.-born Blacks. Male Jamaican-Bahamian-Haitian-born Blacks were more likely to have delayed diagnosis (aOR 2.17, 95% confidence interval [CI] 1.53-3.03; aOR 1.88, 95% CI 1.01-3.44; aOR 1.58, 95%CI 1.58). Findings suggest the need for targeted, culturally relevant interventions to reduce delayed diagnosis incidence among specific Caribbean-born Blacks.
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Affiliation(s)
- Elena Cyrus
- The Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University (FIU), Miami, FL
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
| | - Kristopher Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
| | - Mariana Sanchez
- The Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University (FIU), Miami, FL
| | - Christyl T. Dawson
- The Center for Research on U.S. Latino HIV/AIDS and Drug Abuse (CRUSADA), Florida International University (FIU), Miami, FL
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
| | - Marsha Cameron
- George Washington Milken Institute School of Public Health, Washington, DC
| | - Lorene Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, FL
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, FIU, Miami, FL
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Sheehan DM, Fennie KP, Mauck DE, Maddox LM, Lieb S, Trepka MJ. Retention in HIV Care and Viral Suppression: Individual- and Neighborhood-Level Predictors of Racial/Ethnic Differences, Florida, 2015. AIDS Patient Care STDS 2017; 31:167-175. [PMID: 28414260 DOI: 10.1089/apc.2016.0197] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to estimate racial/ethnic differences in retention in HIV care and viral suppression and to identify related individual and neighborhood determinants. Florida HIV surveillance records of cases aged ≥13 years diagnosed during the years 2000-2014 were analyzed. Retention in care was defined as evidence of ≥2 or more laboratory tests, receipts of prescription, or clinical visits at least 3 months apart during 2015. Viral load suppression was defined as a viral load of <200 copies/mL for the last test in 2015. Multi-level logistic regressions were used to estimate adjusted odds ratios (AORs). Of 65,735 cases, 33.3% were not retained in care, and 40.1% were not virally suppressed. After controlling for individual and neighborhood factors, blacks were at increased odds of nonretention in HIV care [AOR 1.29, 95% confidence interval (CI) 1.23-1.35] and nonviral suppression (AOR 1.55, 95% CI 1.48-1.63) compared with whites. Black and Latino males compared with their female counterparts had higher odds of nonretention and nonviral suppression. Compared with their US-born counterparts, foreign-born blacks and whites, but not Latinos, had higher odds of nonretention and nonviral suppression. Blacks and whites in urban compared with rural areas had higher odds of both outcomes. Disparities in retention in care and viral suppression persist and are not accounted for by differences in age, sex, transmission mode, AIDS diagnosis, neighborhood socioeconomic status, rural/urban residence, or neighborhood racial composition. Further, predictors of poor retention in care and viral suppression appear to differ by race/ethnicity.
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Affiliation(s)
- Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Kristopher P. Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Daniel E. Mauck
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
| | - Lorene M. Maddox
- HIV/AIDS Section, Florida Department of Health, Tallahassee, Florida
| | - Spencer Lieb
- Florida Consortium for HIV/AIDS Research/The AIDS Institute, Tampa, Florida
| | - Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida
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15
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Black-White and Country of Birth Disparities in Retention in HIV Care and Viral Suppression among Latinos with HIV in Florida, 2015. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14020120. [PMID: 28134795 PMCID: PMC5334674 DOI: 10.3390/ijerph14020120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
The study's purpose was to identify HIV, Black-White race, and birth country disparities in retention in HIV care and HIV viral load (VL) suppression among Latinos, in 2015. Florida's surveillance data for Latinos diagnosed with HIV (2000-2014) were merged with American Community Survey data. Multi-level (random effects) models were used to estimate adjusted odds ratios (aOR) for non-retention in care and non-viral load suppression. Blacks and Whites experienced similar odds of non-retention in care. Racial differences in VL suppression disappeared after controlling for neighborhood factors. Compared to U.S.-born Latinos, those born in Mexico (retention aOR 2.00, 95% CI 1.70-2.36; VL 1.85, 95% CI 1.57-2.17) and Central America (retention aOR 1.33, 95% CI 1.16-1.53; VL 1.28, 95% CI 1.12-2.47) were at an increased risk after controlling for individual and neighborhood factors. Among Central Americans, those born in Guatemala (retention aOR 2.39, 95% CI 1.80-3.18; VL 2.20, 95% CI 1.66-2.92) and Honduras (retention aOR 1.39, 95% CI 1.13-1.72; VL 1.42, 95% CI 1.16-1.74) experienced the largest disparities, when compared to U.S.-born Latinos. Disparities in care and treatment exist within the Latino population. Cultural and other factors, unique to Latino Black-White racial and birth country subgroups, should be further studied and considered for intervention.
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16
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Ransome Y, Kawachi I, Braunstein S, Nash D. Structural inequalities drive late HIV diagnosis: The role of black racial concentration, income inequality, socioeconomic deprivation, and HIV testing. Health Place 2016; 42:148-158. [PMID: 27770671 PMCID: PMC5584790 DOI: 10.1016/j.healthplace.2016.09.004] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/29/2016] [Accepted: 09/26/2016] [Indexed: 01/14/2023]
Abstract
In the United States, research is limited on the mechanisms that link socioeconomic and structural factors to HIV diagnosis outcomes. We tested whether neighborhood income inequality, socioeconomic deprivation, and black racial concentration were associated with gender-specific rates of HIV in the advanced stages of AIDS (i.e., late HIV diagnosis). We then examined whether HIV testing prevalence and accessibility mediated any of the associations above. Neighborhoods with highest (relative to lowest) black racial concentration had higher relative risk of late HIV diagnosis among men (RR=1.86; 95%CI=1.15, 3.00) and women (RR=5.37; 95%CI=3.16, 10.43) independent of income inequality and socioeconomic deprivation. HIV testing prevalence and accessibility did not significantly mediate the associations above. Research should focus on mechanisms that link black racial concentration to HIV diagnosis outcomes.
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Affiliation(s)
- Yusuf Ransome
- Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Sarah Braunstein
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Denis Nash
- City University of New York (CUNY) Institute for Implementation Science in Population Health, NY, USA
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17
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Sheehan DM, Trepka MJ, Fennie KP, Prado G, Ibanez G, Maddox LM. Racial/ethnic disparities in delayed HIV diagnosis among men who have sex with men, Florida, 2000-2014. AIDS Care 2016; 29:311-318. [PMID: 27455856 DOI: 10.1080/09540121.2016.1211609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Only about 85% of men who have sex with men (MSM) with human immunodeficiency virus (HIV) have been tested for and diagnosed with HIV. Racial/ethnic disparities in HIV risk and HIV care outcomes exist within MSM. We examined racial/ethnic disparities in delayed HIV diagnosis among MSM. Males aged ≥13 reported to the Florida Enhanced HIV/AIDS Reporting System 2000-2014 with a reported HIV transmission mode of MSM were analyzed. We defined delayed HIV diagnosis as an AIDS diagnosis within three months of the HIV diagnosis. Multilevel logistic regressions were used to estimate adjusted odds ratios (aOR). Of 39,301 MSM, 27% were diagnosed late. After controlling for individual factors, neighborhood socioeconomic status, and rural-urban residence, non-Latino Black MSM had higher odds of delayed diagnosis compared with non-Latino White MSM (aOR 1.15, 95% confidence interval [CI] 1.08-1.23). Foreign birth compared with US birth was a risk factor for Black MSM (aOR 1.27, 95% CI 1.12-1.44), but a protective factor for White MSM (aOR 0.77, 95% CI 0.68-0.87). Rural residence was a risk for Black MSM (aOR 1.79, 95% CI 1.36-2.35) and Latino MSM (aOR 1.87, 95% CI 1.24-2.84), but not for White MSM (aOR 1.26, 95% CI 0.99-1.60). HIV testing barriers particularly affect non-Latino Black MSM. Social and/or structural barriers to testing in rural communities may be significantly contributing to delayed HIV diagnosis among minority MSM.
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Affiliation(s)
- Diana M Sheehan
- a Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA.,b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Mary Jo Trepka
- a Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University , Miami , FL , USA.,b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Kristopher P Fennie
- b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Guillermo Prado
- c Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Gladys Ibanez
- b Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , FL , USA
| | - Lorene M Maddox
- d Florida Department of Health , HIV/AIDS Section , Tallahassee , FL , USA
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18
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Nelson LE, Wilton L, Moineddin R, Zhang N, Siddiqi A, Sa T, Harawa N, Regan R, Dyer TP, Watson CC, Koblin B, Del Rio C, Buchbinder S, Wheeler DP, Mayer KH. Economic, Legal, and Social Hardships Associated with HIV Risk among Black Men who have Sex with Men in Six US Cities. J Urban Health 2016; 93:170-88. [PMID: 26830422 PMCID: PMC4794466 DOI: 10.1007/s11524-015-0020-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We assessed whether economic, legal, and social hardships were associated with human immunodeficiency virus (HIV) risk among a sample of Black men who have sex with men (MSM) and whether associations were moderated by city of residence. The study analyzed baseline and follow-up data from HIV Prevention Trials Network 061 (N = 1553). Binary logistic regression assessed associations between hardships and HIV risk indicators. Multivariate regressions were used to test if city of residence had a moderating effect for hardships and HIV risks. Adjusted analyses showed that Black MSM with recent job loss were more likely to engage in condomless insertive anal intercourse (adjusted odds ratios (AOR) = 1.37, 95% CI 1.01-1.87) and that those with recent financial crisis were more likely to have had two or more male sexual partners in the past 6 months (AOR = 1.65; 95% CI 1.18-2.29). Black MSM with recent convictions were more likely to have a sexually transmitted infection at 6 months (AOR = 3.97; 95% CI 1.58-9.94), while those who were unstably housed were more likely to have a sexually transmitted infection at 12 months (AOR = 1.71; 95%CI 1.02 = 2.86). There were no city of residence and hardship interaction effects on HIV risks. Hardships are important factors that influence HIV risk for Black MSM. Integrating strategies that address structural factors that influence HIV risk may enhance HIV prevention interventions implementation efforts.
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Affiliation(s)
- LaRon E Nelson
- School of Nursing, University of Rochester, Rochester, NY, USA.
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Leo Wilton
- College of Community and Public Affairs, State University of New York at Binghamton, Binghamton, NY, USA
- Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
| | - Rahim Moineddin
- Faculty of Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Nanhua Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, Divisions of Epidemiology and Social & Behavioural Health Sciences, University of Toronto, Toronto, ON, Canada
- Gillings School of Public Health, Department of Health Behavior, University of North Carolina Chapel Hill, Chapel Hill, NC, USA
| | - Ting Sa
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Nina Harawa
- College of Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
- David Geffen School of Medicine, General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
| | - Rotrease Regan
- David Geffen School of Medicine, Department of Family Medicine, University of California Los Angeles, Los Angeles, CA, USA
- School of Medicine, Division of Infectious Diseases, Emory University, Atlanta, GA, USA
| | - Typhanye Penniman Dyer
- School of Public Health, Department of Epidemiology and Biostatistics, University of Maryland College Park, College Park, MD, USA
| | | | | | - Carlos Del Rio
- Rollins School of Public Health, Hubert Department of Global Health and School of Medicine, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Susan Buchbinder
- San Francisco Department of Public Health, HIV Research Section, San Francisco, CA, USA
| | - Darrell P Wheeler
- School of Social Welfare, State University of New York Albany, Albany, NY, USA
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19
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Rebeiro PF, Gange SJ, Horberg MA, Abraham AG, Napravnik S, Samji H, Yehia BR, Althoff KN, Moore RD, Kitahata MM, Sterling TR, Curriero FC. Geographic Variations in Retention in Care among HIV-Infected Adults in the United States. PLoS One 2016; 11:e0146119. [PMID: 26752637 PMCID: PMC4708981 DOI: 10.1371/journal.pone.0146119] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To understand geographic variations in clinical retention, a central component of the HIV care continuum and key to improving individual- and population-level HIV outcomes. Design We evaluated retention by US region in a retrospective observational study. Methods Adults receiving care from 2000–2010 in 12 clinical cohorts of the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) contributed data. Individuals were assigned to Centers for Disease Control and Prevention (CDC)-defined regions by residential data (10 cohorts) and clinic location as proxy (2 cohorts). Retention was ≥2 primary HIV outpatient visits within a calendar year, >90 days apart. Trends and regional differences were analyzed using modified Poisson regression with clustering, adjusting for time in care, age, sex, race/ethnicity, and HIV risk, and stratified by baseline CD4+ count. Results Among 78,993 adults with 444,212 person-years of follow-up, median time in care was 7 years (Interquartile Range: 4–9). Retention increased from 2000 to 2010: from 73% (5,000/6,875) to 85% (7,189/8,462) in the Northeast, 75% (1,778/2,356) to 87% (1,630/1,880) in the Midwest, 68% (8,451/12,417) to 80% (9,892/12,304) in the South, and 68% (5,147/7,520) to 72% (6,401/8,895) in the West. In adjusted analyses, retention improved over time in all regions (p<0.01, trend), although the average percent retained lagged in the West and South vs. the Northeast (p<0.01). Conclusions In our population, retention improved, though regional differences persisted even after adjusting for demographic and HIV risk factors. These data demonstrate regional differences in the US which may affect patient care, despite national care recommendations.
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Affiliation(s)
- Peter F. Rebeiro
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- * E-mail:
| | - Stephen J. Gange
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland, United States of America
| | - Alison G. Abraham
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sonia Napravnik
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Hasina Samji
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Baligh R. Yehia
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Keri N. Althoff
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Richard D. Moore
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Mari M. Kitahata
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Timothy R. Sterling
- Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Frank C. Curriero
- Johns Hopkins University, Baltimore, Maryland, United States of America
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Black-White Latino Racial Disparities in HIV Survival, Florida, 2000-2011. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010009. [PMID: 26703656 PMCID: PMC4730400 DOI: 10.3390/ijerph13010009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 09/20/2015] [Accepted: 09/23/2015] [Indexed: 01/10/2023]
Abstract
This research aimed to estimate Black/White racial disparities in all-cause mortality risk among HIV-positive Latinos. Florida surveillance data for Latinos diagnosed with HIV (2000–2008) were merged with 2007–2011 American Community Survey data. Crude and adjusted hazard ratios (aHR) were calculated using multi-level Cox regression. Of 10,903 HIV-positive Latinos, 8.2% were Black and 91.9% White. Black Latinos were at increased mortality risk compared with White Latinos after controlling for individual and neighborhood factors (aHR 1.40, 95% confidence interval (CI) 1.21–1.62). In stratified analyses, risk factors for Black Latinos included: age ≥60 years compared with ages 13–19 (aHR 4.63, 95% CI 1.32–16.13); US birth compared with foreign birth (aHR 1.56, 95% CI 1.16–2.11); diagnosis of AIDS within three months of HIV diagnosis (aHR 3.53, 95% CI 2.64–4.74); residence in the 3rd (aHR 1.82, 95% CI 1.13–2.94) and 4th highest quartiles (aHR 1.79, 95% CI 1.12–2.86) of neighborhood poverty compared with the lowest quartile; and residence in neighborhood with 25%–49% (aHR 1.59, 95% CI 1.07–2.42) and ≥50% Latinos compared with <25% Latinos (aHR 1.58, 95% CI 1.03–2.42). Significant racial disparities in HIV survival exist among Latinos. Differential access to—and quality of—care and perceived/experienced racial discrimination may be possible explanations.
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21
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Sheehan DM, Trepka MJ, Fennie KP, Prado G, Madhivanan P, Dillon FR, Maddox L. Individual and neighborhood predictors of mortality among HIV-positive Latinos with history of injection drug use, Florida, 2000-2011. Drug Alcohol Depend 2015. [PMID: 26208792 PMCID: PMC4536123 DOI: 10.1016/j.drugalcdep.2015.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The objectives are to examine disparities in all-cause mortality risk among HIV-positive Latinos with injection drug use (IDU) history, and to identify individual- and neighborhood-level predictors. METHODS Florida surveillance data for persons diagnosed with HIV 2000-2008 were merged with 2007-2011 administrative data from the American Community Survey. Hazard ratios (HR) were calculated using multi-level weighted Cox regression adjusting for individual and neighborhood (ZCTA-level) factors. RESULTS Of 10,989 HIV-positive Latinos, 10.3% had IDU history. Latinos with IDU history were at increased mortality risk compared with Latinos without IDU history after controlling for individual and neighborhood factors (adjusted HR [aHR] 1.61, 95% confidence interval [CI] 1.43-1.80). Factors associated with mortality for those with IDU history included: being 40-59 (aHR 6.48, 95% CI 1.41-121.05) and ≥60 years (aHR 18.75, 95% CI 3.83-356.45) compared with 13-19 years of age; being diagnosed with AIDS within 3 months of HIV (aHR 2.31, 95% CI 1.87-2.86); residing in an area with ≥50% Latinos compared with <25% Latinos (aHR 1.56, 95% CI 1.19-2.04); and residing in a rural compared with an urban area at the time of diagnosis (aHR 1.73, 95% CI 1.06-2.70). Race and neighborhood poverty were not predictors among those with IDU, but were among those without. CONCLUSION HIV-positive Latinos with IDU history are at increased mortality risk and have unique contributing factors. Tertiary prevention strategies should target those who are older, diagnosed at later stages, and those who live in predominantly Latino and rural areas.
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Affiliation(s)
- Diana M. Sheehan
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (CSALUD), Florida International University, 11200 SW 8th St, Miami, FL, 33199,Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199
| | - Mary Jo Trepka
- Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, 11200 SW 8th St, Miami, FL 33199, United States; Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL 33199, United States.
| | - Kristopher P. Fennie
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199
| | - Guillermo Prado
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, Miami, FL, 33136
| | - Purnima Madhivanan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, FL, 33199
| | - Frank R. Dillon
- Department of Educational and Counseling Psychology, School of Education, University at Albany – State University of New York, 1400 Washington Ave, Albany, NY, 12222
| | - Lorene Maddox
- HIV/AIDS Section, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, Florida 32399
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Weissman S, Duffus WA, Vyavaharkar M, Samantapudi AV, Shull KA, Stephens TG, Chakraborty H. Defining the rural HIV epidemic: correlations of 3 definitions--South Carolina, 2005-2011. J Rural Health 2013; 30:275-83. [PMID: 24329575 DOI: 10.1111/jrh.12057] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To gain a better understanding of the HIV epidemic in rural South Carolina (SC) by contrasting 3 definitions of rural and urban areas. METHODS The sample included newly diagnosed HIV cases aged ≥18 years in SC between January 1, 2005, and December 31, 2011. Each individual was assigned a rural or urban status as defined by the Office of Management and Budget (OMB), Census Bureau (CB), and Rural Urban Commuting Area (RUCA) classifications. Descriptive statistics were conducted to compare sociodemographic characteristics, CD4 counts, viral loads, and time to AIDS diagnosis between rural and urban populations. Kappa statistics measured the agreement between the 3 definitions of rurality. FINDINGS Depending on the definition used, the proportion of newly diagnosed HIV cases in rural areas varied from 23.3% to 32.0%. Based on the OMB and RUCA definitions, rural residents with HIV were more likely to be older, women, black, and non-Hispanic, report heterosexual contact, and have an AIDS diagnosis within 1 year of their HIV diagnosis. The OMB and RUCA definitions had a nearly perfect agreement (kappa = 0.8614; 95% CI = 0.8457, 0.8772), while poor agreements were noted between the OMB and CB or the RUCA and CB definitions. CONCLUSION When examining the rural HIV epidemic, how "rural" is defined matters. Using 3 definitions of rurality, statistically significant differences were found in demographic characteristics, timing of HIV diagnosis and the proportion of rural residents diagnosed with HIV in SC. The findings suggest possible misclassification biases that may adversely influence services and resource distribution.
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Affiliation(s)
- Sharon Weissman
- Division of Infectious Diseases, Department of Medicine, University of South Carolina, Columbia, South Carolina
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Trepka MJ, Niyonsenga T, Maddox LM, Lieb S. Rural AIDS diagnoses in Florida: changing demographics and factors associated with survival. J Rural Health 2013; 29:266-80. [PMID: 23802929 PMCID: PMC3695411 DOI: 10.1111/j.1748-0361.2012.00449.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare demographic characteristics and predictors of survival of rural residents diagnosed with acquired immunodeficiency syndrome (AIDS) with those of urban residents. METHODS Florida surveillance data for people diagnosed with AIDS during 1993-2007 were merged with 2000 Census data using ZIP code tabulation areas (ZCTAs). Rural status was classified based on the ZCTA's rural-urban commuting area classification. Survival rates were compared between rural and urban areas using survival curves and Cox proportional hazards models controlling for demographic, clinical, and area-level socioeconomic and health care access factors. FINDINGS Of the 73,590 people diagnosed with AIDS, 1,991 (2.7%) resided in rural areas. People in the most recent rural cohorts were more likely than those in earlier cohorts to be female, non-Hispanic black, older, and have a reported transmission mode of heterosexual sex. There were no statistically significant differences in the 3-, 5-, or 10-year survival rates between rural and urban residents. Older age at the time of diagnosis, diagnosis during the 1993-1995 period, other/unknown transmission mode, and lower CD4 count/percent categories were associated with lower survival in both rural and urban areas. In urban areas only, being non-Hispanic black or Hispanic, being US born, more poverty, less community social support, and lower physician density were also associated with lower survival. CONCLUSIONS In rural Florida, the demographic characteristics of people diagnosed with AIDS have been changing, which may necessitate modifications in the delivery of AIDS-related services. Rural residents diagnosed with AIDS did not have a significant survival disadvantage relative to urban residents.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida 33199, USA.
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