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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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2
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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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3
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Kay ES, Lee Y, Scheinert M, Sewell J, Raper J, Willig J, Batey DS. "If I have to drive 100 miles, I'll drive 100 miles to get it": a qualitative exploration of HIV care travel behavior. AIDS Care 2023; 35:1612-1618. [PMID: 36585943 PMCID: PMC10311233 DOI: 10.1080/09540121.2022.2162839] [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: 12/20/2021] [Accepted: 12/22/2022] [Indexed: 01/01/2023]
Abstract
ABSTRACTAlabama depends heavily on Ryan White HIV/AIDS Program (RWHAP) funding, yet patient enrollment at one large, RWHAP-funded, academically-affiliated HIV clinic in Alabama has steadily increased each year, with approximately 20% bypassing more proximal RWHAP clinics. To understand reasons why patients travel long distances and bypass closer clinics to receive care, we conducted eight focus groups over Zoom, each containing between 2-3 participants (n = 18) and applied thematic analysis to code the data. Primary themes included: (1) Reasons for Traveling Long Distances to Receive HIV Medical Care, (2) Experiences with HIV Medical Care during the COVID-19 Pandemic, and (3) Travel Challenges. Some participants were attracted by the clinic's one-stop-shop model, while others eschewed local clinics to avoid status disclosure. An overarching travel challenge was lack of transportation, yet most participants favored in-person appointments over telehealth despite driving long distances. Future research should explore patient attitudes towards telehealth in greater depth.
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Affiliation(s)
- Emma Sophia Kay
- Magic City Research Institute, Birmingham AIDS Outreach,
Birmingham, AL, USA
| | - Yookyong Lee
- Department of Social Work, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Mary Scheinert
- Children's of Alabama, University of Alabama at
Birmingham, Birmingham, AL, USA
| | - Josh Sewell
- Division of Infectious Diseases, University of Alabama at
Birmingham, Birmingham, Alabama, USA
| | - James Raper
- Division of Infectious Diseases, University of Alabama at
Birmingham, Birmingham, Alabama, USA
| | - James Willig
- Division of Infectious Diseases, University of Alabama at
Birmingham, Birmingham, Alabama, USA
| | - D. Scott Batey
- Magic City Research Institute, Birmingham AIDS Outreach,
Birmingham, AL, USA
- School of Social Work, Tulane University, New Orleans,
Louisiana, USA
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4
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Webster JL, Thorpe LE, Duncan DT, Goldstein ND. Accessibility of HIV Services in Philadelphia: Location-Allocation Analysis. Am J Prev Med 2022; 63:1053-1061. [PMID: 36057459 PMCID: PMC10152388 DOI: 10.1016/j.amepre.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION As the first step in the HIV care continuum, timely diagnosis is central to reducing transmission of the virus and ending the HIV epidemic. Studies have shown that distance from a testing site is essential for ease of access to services and educational material. This study shows how location-allocation analysis can be used to improve allocation of HIV testing services utilizing existing publicly available data from 2015 to 2019 on HIV prevalence, testing site location, and factors related to HIV in Philadelphia, Pennsylvania. METHODS The ArcGIS Location-Allocation analytic tool was used to calculate locations for HIV testing sites using a method that minimizes the distance between demand-point locations and service facilities. ZIP code level demand was initially specified on the basis of the percentage of late HIV diagnoses and in a sensitivity analysis on the basis of a composite of multiple factors. Travel time and distance from demand to facilities determined the facility location allocation. This analysis was conducted from 2021 to 2022. RESULTS Compared with the 37 facilities located in 20 (43%) Philadelphia ZIP codes, the model proposed reallocating testing facilities to 37 (79%) ZIP codes using percent late diagnoses to define demand. On average, this would reduce distance to the facilities by 65% and travel time to the facilities by 56%. Results using the sensitivity analysis were similar. CONCLUSIONS A wider distribution of HIV testing services across the city of Philadelphia may reduce distance and travel time to facilities, improve accessibility of testing, and in turn increase the percentage of people with knowledge of their status.
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Affiliation(s)
- Jessica L Webster
- 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, Mailman School of Public Health, Columbia University, New York, New York
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania.
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5
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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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Rudolph AE. Integrating a web-based survey application into Qualtrics to collect risk location data for HIV prevention research. AIDS Care 2022; 34:397-403. [PMID: 34839777 PMCID: PMC9016781 DOI: 10.1080/09540121.2021.2008860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aspects of the physical and social environment play an important role in shaping HIV-related risk/prevention behaviors and access to prevention and treatment services. Here, we describe the feasibility of integrating a web-based survey application to collect risk locations into Qualtrics and compare this approach with a JavaScript-based alternative. Between 2017 and 2018, we enrolled 29 persons living with HIV in Boston Massachusetts to complete an interviewer-administered questionnaire using Qualtrics. Surveys collected demographics; sex/drug use risk behaviors; locations where participants met sex partners, had condomless sex, attended group sex events, and shared a syringe or injection equipment with someone else (up to 10 locations each); and the locations where participants (a) had sex with each sex partner (past 6 months) and (b) used drugs with each drug use partner (past 6 months). Location data were collected using embedded links to an encrypted web-based survey application. Overall, participants provided valid coordinates 93% of the time; when an exact location was not provided, a neighborhood was provided instead, resulting in little missing data. Our findings suggest that this web-based data collection tool (alone or with embedded links in Qualtrics) is a feasible and secure option for collecting risk location data.
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Affiliation(s)
- Abby E. Rudolph
- Department of Epidemiology and Biostatistics, Temple University College of Public Health, Philadelphia, USA
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Sanchez-Dominguez M, Leyva-Flores R, Infante-Xibille C, Texcalac-Sangrador JL, Lamadrid-Figueroa H. Use of self-help groups by people living with HIV in Central America. CAD SAUDE PUBLICA 2022; 38:e00007922. [DOI: 10.1590/0102-311xen007922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 09/16/2022] [Indexed: 11/22/2022] Open
Abstract
Self-help groups (SHGs) for people living with HIV (PLHIV) are organizations created by the community to provide individuals with security, affection, improved self-esteem, and a sense of belonging. However, SHGs have also been used by the government to help implement HIV control policies. This study aimed to identify the characteristics associated with the use of SHGs by PLHIV and the routes and displacement patterns adopted by users. An analytical cross-sectional study was conducted based on data collected in six Central American countries during 2012. Using a list of SHGs, a random sampling was conducted in two stages. Firstly, the SHGs were selected. Then, the selected SHGs were visited and every third user who attended the SHG was surveyed. Logistic regression models were used to identify the characteristics associated with the use of SHGs and with attending the nearest SHGs. A spatial analysis was performed to identify the routes followed by users to reach the SHGs from their home communities. We found that the characteristics significantly associated with higher odds of SHG usage were country of residence and schooling level. The average and median distances traveled by users to attend SHGs were 20 and 5 kilometers, respectively. PLHIV do not use the SHGs closest to their locality, perhaps for fear of stigma and discrimination. We recommend that research on this topic use a mixed qualitative-quantitative methodology to better understand utilization decisions, user expectations, and the degree to which these are being met.
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Millett GA, Honermann B, Jones A, Lankiewicz E, Sherwood J, Blumenthal S, Sayas A. White Counties Stand Apart: The Primacy of Residential Segregation in COVID-19 and HIV Diagnoses. AIDS Patient Care STDS 2020; 34:417-424. [PMID: 32833494 PMCID: PMC7585613 DOI: 10.1089/apc.2020.0155] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emerging epidemiological data suggest that white Americans have a lower risk of acquiring COVID-19. Although many studies have pointed to the role of systemic racism in COVID-19 racial/ethnic disparities, few studies have examined the contribution of racial segregation. Residential segregation is associated with differing health outcomes by race/ethnicity for various diseases, including HIV. This commentary documents differing HIV and COVID-19 outcomes and service delivery by race/ethnicity and the crucial role of racial segregation. Using publicly available Census data, we divide US counties into quintiles by percentage of non-Hispanic white residents and examine HIV diagnoses and COVID-19 per 100,000 population. HIV diagnoses decrease as the proportion of white residents increase across US counties. COVID-19 diagnoses follow a similar pattern: Counties with the highest proportion of white residents have the fewest cases of COVID-19 irrespective of geographic region or state political party inclination (i.e., red or blue states). Moreover, comparatively fewer COVID-19 diagnoses have occurred in primarily white counties throughout the duration of the US COVID-19 pandemic. Systemic drivers place racial minorities at greater risk for COVID-19 and HIV. Individual-level characteristics (e.g., underlying health conditions for COVID-19 or risk behavior for HIV) do not fully explain excess disease burden in racial minority communities. Corresponding interventions must use structural- and policy-level solutions to address racial and ethnic health disparities.
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Affiliation(s)
| | - Brian Honermann
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Austin Jones
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Elise Lankiewicz
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Jennifer Sherwood
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Susan Blumenthal
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
| | - Asal Sayas
- amfAR, Foundation for AIDS Research, Washington, District of Columbia, USA
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Sanchez-Dominguez MS, Lamadrid-Figueroa H, Leyva-Flores R, Infante-Xibille C. Estimating the effectiveness of self-help groups on the adoption of secondary preventive measures by people living with HIV in Central America, 2012. BMC Health Serv Res 2020; 20:451. [PMID: 32448289 PMCID: PMC7245741 DOI: 10.1186/s12913-020-05235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 04/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to UNAIDS, the HIV epidemic has stabilized. This as a result of increased condom use and greater access to coverage for antiretroviral therapy (ART). In Central America, civil society organizations work with self-help groups (SHGs) organized in conjunction with public health services to implement interventions seeking to increase condom use and ART adherence for people living with HIV (PLH). METHOD To analyze the effectiveness of SHGs in Central America aimed on increasing condom use and ART adherence in PLH, We conducted a cross-sectional study using a questionnaire and a random sample of 3024 intervention group and 1166 control group. Based on propensity scoring and one-to-one matching (with replacement), we formed a comparison group to help estimate the effectiveness of the above-mentioned intervention on two outcome variables (condom use and ART adherence). The internal consistency of the results was tested through weighted least squares (WLS) and instrumental variable (IV) regression. RESULTS Although bivariate comparisons yielded differences between intervention and control group, we found no evidence that the intervention was effective; nor did we find evidence of a heterogeneous impact among countries after adjusting for propensity scoring and the IV model. The impact observed after performing raw comparisons of the indicators may be attributable to self-selection on the part of PLH rather than to the SHGs strategy. Our results demonstrate that it is imperative to use rigorous intervention evaluation methodology to validate the consistency of results. CONCLUSIONS The intervention had no impact on the outcome indicators measured. We recommend prioritizing the allocation of economic resources for the implementation of interventions with previously proven effectiveness. We also recommend that future studies explore why the intervention failed to produce the expected impact on condom use and ART adherence.
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Affiliation(s)
| | - Hector Lamadrid-Figueroa
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad 655, Santa Maria Ahuacatitlan, Cp. 62100 Cuernavaca, Morelos Mexico
| | - Rene Leyva-Flores
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Cesar Infante-Xibille
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Olatosi B, Zhang J, Weissman S, Hu J, Haider MR, Li X. Using big data analytics to improve HIV medical care utilisation in South Carolina: A study protocol. BMJ Open 2019; 9:e027688. [PMID: 31326931 PMCID: PMC6661700 DOI: 10.1136/bmjopen-2018-027688] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 03/28/2019] [Accepted: 06/04/2019] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Linkage and retention in HIV medical care remains problematic in the USA. Extensive health utilisation data collection through electronic health records (EHR) and claims data represent new opportunities for scientific discovery. Big data science (BDS) is a powerful tool for investigating HIV care utilisation patterns. The South Carolina (SC) office of Revenue and Fiscal Affairs (RFA) data warehouse captures individual-level longitudinal health utilisation data for persons living with HIV (PLWH). The data warehouse includes EHR, claims and data from private institutions, housing, prisons, mental health, Medicare, Medicaid, State Health Plan and the department of health and human services. The purpose of this study is to describe the process for creating a comprehensive database of all SC PLWH, and plans for using BDS to explore, identify, characterise and explain new predictors of missed opportunities for HIV medical care utilisation. METHODS AND ANALYSIS This project will create person-level profiles guided by the Gelberg-Andersen Behavioral Model and describe new patterns of HIV care utilisation. The population for the comprehensive database comes from statewide HIV surveillance data (2005-2016) for all SC PLWH (N≈18000). Surveillance data are available from the state health department's enhanced HIV/AIDS Reporting System (e-HARS). Additional data pulls for the e-HARS population will include Ryan White HIV/AIDS Program Service Reports, Health Sciences SC data and Area Health Resource Files. These data will be linked to the RFA data and serve as sources for traditional and vulnerable domain Gelberg-Anderson Behavioral Model variables. The project will use BDS techniques such as machine learning to identify new predictors of HIV care utilisation behaviour among PLWH, and 'missed opportunities' for re-engaging them back into care. ETHICS AND DISSEMINATION The study team applied for data from different sources and submitted individual Institutional Review Board (IRB) applications to the University of South Carolina (USC) IRB and other local authorities/agencies/state departments. This study was approved by the USC IRB (#Pro00068124) in 2017. To protect the identity of the persons living with HIV (PLWH), researchers will only receive linked deidentified data from the RFA. Study findings will be disseminated at local community forums, community advisory group meetings, meetings with our state agencies, local partners and other key stakeholders (including PLWH, policy-makers and healthcare providers), presentations at academic conferences and through publication in peer-reviewed articles. Data security and patient confidentiality are the bedrock of this study. Extensive data agreements ensuring data security and patient confidentiality for the deidentified linked data have been established and are stringently adhered to. The RFA is authorised to collect and merge data from these different sources and to ensure the privacy of all PLWH. The legislatively mandated SC data oversight council reviewed the proposed process stringently before approving it. Researchers will get only the encrypted deidentified dataset to prevent any breach of privacy in the data transfer, management and analysis processes. In addition, established secure data governance rules, data encryption and encrypted predictive techniques will be deployed. In addition to the data anonymisation as a part of privacy-preserving analytics, encryption schemes that protect running prediction algorithms on encrypted data will also be deployed. Best practices and lessons learnt about the complex processes involved in negotiating and navigating multiple data sharing agreements between different entities are being documented for dissemination.
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Affiliation(s)
- Bankole Olatosi
- Health Services, Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jiajia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Sharon Weissman
- Internal Medicine, School of Medicine, University of South Carolina, Columbia, South Carolina, USA
| | - Jianjun Hu
- Department of Computer Science & Engineering, College of Engineering, University of South Carolina, Columbia, South Carolina, USA
| | - Mohammad Rifat Haider
- Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Xiaoming Li
- Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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11
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Chen YT, Kolak M, Duncan DT, Schumm P, Michaels S, Fujimoto K, Schneider JA. Neighbourhoods, networks and pre-exposure prophylaxis awareness: a multilevel analysis of a sample of young black men who have sex with men. Sex Transm Infect 2019; 95:228-235. [PMID: 30518619 DOI: 10.1136/sextrans-2018-053639] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/17/2018] [Accepted: 10/28/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Young black men who have sex with men (YBMSM) in the USA represent a subgroup that has the highest HIV incidence among the overall population. In the USA, pre-exposure prophylaxis (PrEP) is an effective prevention intervention to prevent HIV acquisition when taken regularly. Neighbourhood and network factors may relate to PrEP awareness, but have not been studied in YBMSM. This study aimed to examine the relationship of neighbourhood and network characteristics with PrEP awareness among YBMSM. METHODS We used data collected from a sample of 618 YBMSM in Chicago (2013-2014). Home addresses were collected for participants and enumerated network members. Administrative data (eg, 2014 American Community Survey, Chicago Department of Public Health) were used to describe residence characteristics. Network member characteristics were also collected (eg, sexual partners' sex-drug use, confidant network members who were also MSM). Multilevel analysis was performed to examine the relationships of neighbourhood and network characteristics to PrEP awareness. RESULTS Higher neighbourhood-level educational attainment (adjusted odds ratio (aOR) 1.02, p=0.03) and greater primary care density (aOR 1.38, p=0.01) were associated with greater PrEP awareness; greater neighbourhood alcohol outlet density (aOR 0.52, p=0.004) was associated with less PrEP awareness. Sexual network members residing in the same neighbourhood as the participants (aOR 2.58, p=0.03) and discussions around avoiding HIV acquisition with confidants (aOR 2.26, p=0.04) were associated with greater PrEP awareness. CONCLUSIONS The results suggest that neighbourhood and network characteristics can influence PrEP awareness in YBMSM. Additional studies are needed to understand the influences of neighbourhood (eg, MSM serving venues) and network (eg, peer to peer communication) characteristics on dissemination of PrEP information, uptake and adherence and the related mechanisms behind the associations.
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Affiliation(s)
- Yen-Tyng Chen
- Chicago Center for HIV Elimination, Chicago, Illinois, USA
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Marynia Kolak
- Center for Spatial Data Science, University of Chicago, Chicago, Illinois, USA
| | - Dustin T Duncan
- NYU Spatial Epidemiology Lab, Department of Population Health, School of Medicine, New York University, New York City, New York, USA
| | - Phil Schumm
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | | | - Kayo Fujimoto
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, Chicago, Illinois, USA
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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12
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Masiano SP, Martin EG, Bono RS, Dahman B, Sabik LM, Belgrave FZ, Adimora AA, Kimmel AD. Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban-rural differences. J Int AIDS Soc 2019; 22:e25286. [PMID: 31111684 PMCID: PMC6527947 DOI: 10.1002/jia2.25286] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/30/2019] [Indexed: 11/09/2022] Open
Abstract
Achieving US state and municipal benchmarks to end the HIV epidemic and promote health equity requires access to comprehensive HIV care. However, this care may not be geographically accessible for all people living with HIV (PLHIV). We estimated county-level drive time and suboptimal geographic accessibility to HIV care across the contiguous US, assessing regional and urban-rural differences. We integrated publicly available data from four federal databases to identify and geocode sites providing comprehensive HIV care in 2015, defined as the co-located provision of core HIV medical care and support services. Leveraging street network, US Census and HIV surveillance data (2014), we used geographic analysis to estimate the fastest one-way drive time between the population-weighted county centroid and the nearest site providing HIV care for counties reporting at least five diagnosed HIV cases. We summarized HIV care sites, county-level drive time, population-weighted drive time and suboptimal geographic accessibility to HIV care, by US region and county rurality (2013). Geographic accessibility to HIV care was suboptimal if drive time was >30 min, a common threshold for primary care accessibility in the general US population. Tests of statistical significance were not performed, since the analysis is population-based. We identified 671 HIV care sites across the US, with 95% in urban counties. Nationwide, the median county-level drive time to HIV care is 69 min (interquartile range (IQR) 66 min). The median county-level drive time to HIV care for rural counties (90 min, IQR 61) is over twice that of urban counties (40 min, IQR 48), with the greatest urban-rural differences in the West. Nationally, population-weighted drive time, an approximation of individual-level drive time, is over five times longer in rural counties than in urban counties. Geographic access to HIV care is suboptimal for over 170,000 people diagnosed with HIV (19%), with over half of these individuals from the South and disproportionately the rural South. Nationally, approximately 80,000 (9%) drive over an hour to receive HIV care. Suboptimal geographic accessibility to HIV care is an important structural barrier in the US, particularly for rural residents living with HIV in the South and West. Targeted policies and interventions to address this challenge should become a priority.
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Affiliation(s)
- Steven P Masiano
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Erika G Martin
- Department of Public Administration and PolicyUniversity at Albany‐State University of New YorkAlbanyNYUSA
| | - Rose S Bono
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Bassam Dahman
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
| | - Lindsay M Sabik
- Department of Health Policy and ManagementUniversity of PittsburghPittsburghPAUSA
| | - Faye Z Belgrave
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Adaora A Adimora
- Departments of Medicine and EpidemiologyUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - April D Kimmel
- Department of Health Behavior and PolicyVirginia Commonwealth University School of MedicineRichmondVAUSA
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Wiewel EW, Borrell LN, Jones HE, Maroko AR, Torian LV. Healthcare facility characteristics associated with achievement and maintenance of HIV viral suppression among persons newly diagnosed with HIV in New York City. AIDS Care 2019; 31:1484-1493. [PMID: 30909714 DOI: 10.1080/09540121.2019.1595517] [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: 10/27/2022]
Abstract
Health care facility characteristics have been shown to influence intermediary health outcomes among persons with HIV, but few longitudinal studies of suppression have included these characteristics. We studied the association of these characteristics with the achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older newly diagnosed with HIV between 2006 and 2012. The NYC HIV surveillance registry provided individual and facility data (N = 12,547 persons). Multivariable proportional hazards models estimated the likelihood of individual achievement and maintenance of suppression by type of facility, patient volume, and distance from residence, accounting for facility clustering and for individual-level confounders. Viral suppression was achieved within 12 months by 44% and at a later point by another 29%. Viral suppression occurred at a lower rate in facilities with low HIV patient volume (e.g., 10-24 diagnoses per year vs. ≥75, adjusted hazard ratio [AHR] = 0.87, 95% confidence interval [CI] 0.79-0.95) and in screening/diagnosis sites (vs. hospitals, AHR = 0.86, 95% CI 0.80-0.92). Among persons achieving viral suppression, 18% experienced virologic failure within 12 months and 24% later. Those receiving care at large outpatient facilities or large private practices had a lower rate of virologic failure (e.g., large outpatient facilities vs. large hospitals, AHR = 0.63, 95% CI 0.53-0.75). Achievement and maintenance of viral suppression were associated with facilities with higher HIV-positive caseloads. Some facilities with small caseloads and screening/diagnosis sites may need stronger care or referral systems to help persons with HIV achieve and maintain viral suppression.
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Affiliation(s)
- Ellen W Wiewel
- Division of Disease Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
| | - Luisa N Borrell
- Epidemiology and Biostatistics, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Heidi E Jones
- Epidemiology and Biostatistics, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Andrew R Maroko
- Environmental, Occupational, and Geospatial Health Sciences, City University of New York (CUNY) Graduate School of Public Health and Health Policy , New York , NY , USA
| | - Lucia V Torian
- Division of Disease Control, New York City Department of Health and Mental Hygiene , Long Island City , NY , USA
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Ojikutu BO, Bogart LM, Mayer KH, Stopka TJ, Sullivan PS, Ransome Y. Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey. JMIR Public Health Surveill 2019; 5:e12405. [PMID: 30714945 PMCID: PMC6378549 DOI: 10.2196/12405] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 01/18/2023] Open
Abstract
Background Uptake of pre-exposure prophylaxis (PrEP) among black individuals in the United States is low and may be associated with the limited availability of clinics where PrEP is prescribed. Objective We aimed to determine the association between spatial access to clinics where PrEP is prescribed and willingness to use PrEP. Methods We identified locations of clinics where PrEP is prescribed from AIDSVu.org and calculated the density of PrEP clinics per 10,000 residents according to the ZIP code. Individual-level data were obtained from the 2016 National Survey on HIV in the Black Community. We used multilevel modelling to estimate the association between willingness to use PrEP and clinic density among participants with individual-level (HIV risk, age, gender, education, income, insurance, doctor visit, census region, urban/rural residence) and ZIP code–level (%poverty, %unemployed, %uninsured, %black population, and density of health care facilities) variables. Results All participants identified as black/African American. Of the 787 participants, 45% were men and 23% were found to be at high risk based on the self-reported behavioral characteristics. The mean age of the participants was 34 years (SD 9), 54% of participants resided in the South, and 26% were willing to use PrEP. More than one-third (38%) of the sample had to drive more than 1 hour to access a PrEP provider. Participants living in areas with higher PrEP clinic density were significantly more willing to use PrEP (one SD higher density of PrEP clinics per 10,000 population was associated with 16% higher willingness [adjusted prevalence ratio=1.16, 95% CI: 1.03-1.31]). Conclusions Willingness to use PrEP was associated with spatial availability of clinics where providers prescribe PrEP in this nationally representative sample of black African Americans.
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Affiliation(s)
- Bisola O Ojikutu
- Department of Medicine, Brigham and Women's Hospital, Division of Global Health Equity, Harvard Medical School, Boston, MA, United States
| | | | | | - Thomas J Stopka
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA, United States
| | - Patrick S Sullivan
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, United States
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, United States
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15
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Jefferson KA, Kersanske LS, Wolfe ME, Braunstein SL, Haardörfer R, Des Jarlais DC, Campbell ANC, Cooper HL. Place-based predictors of HIV viral suppression and durable suppression among heterosexuals in New York city. AIDS Care 2018; 31:864-874. [PMID: 30477307 DOI: 10.1080/09540121.2018.1545989] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Scant research has explored place-based correlates of achieving and maintaining HIV viral load suppression among heterosexuals living with HIV. We conducted multilevel analyses to examine associations between United Hospital Fund (UHF)-level characteristics and individual-level viral suppression and durable viral suppression among individuals with newly diagnosed HIV in New York City (NYC) who have heterosexual HIV transmission risk. Individual-level independent and dependent variables came from NYC's HIV surveillance registry for individuals diagnosed with HIV in 2009-2013 (N = 3,159; 57% virally suppressed; 36% durably virally suppressed). UHF-level covariates included measures of food distress, demographic composition, neighborhood disadvantage and affluence, healthcare access, alcohol outlet density, residential vacancy, and police stop and frisk rates. We found that living in neighborhoods where a larger percent of residents were food distressed was associated with not maintaining viral suppression. If future research should confirm this is a causal association, community-level interventions targeting food distress may improve the health of people living with HIV and reduce the risk of forward transmission.
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Affiliation(s)
- Kevin A Jefferson
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
| | - Laura S Kersanske
- b New York City Department of Health and Mental Hygiene , Queens , USA
| | - Mary E Wolfe
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
| | | | - Regine Haardörfer
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
| | | | - Aimee N C Campbell
- d Department of Psychiatry, New York State Psychiatric Institute , Columbia University Medical Center , New York , USA
| | - Hannah Lf Cooper
- a Behavioral Sciences and Health Education , Rollins School of Public Health at Emory University , Atlanta , USA
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16
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Kimmel AD, Masiano SP, Bono RS, Martin EG, Belgrave FZ, Adimora AA, Dahman B, Galadima H, Sabik LM. Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South. AIDS Care 2018. [DOI: http://doi.org.10.1080/09540121.2018.1476656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Steven P. Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Erika G. Martin
- Nelson A. Rockefeller Institute of Government, Albany, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs & Policy, University at Albany, Albany, USA
| | - Faye Z. Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Adaora A. Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Hadiza Galadima
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, USA
| | - Lindsay M. Sabik
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, USA
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17
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Kimmel AD, Masiano SP, Bono RS, Martin EG, Belgrave FZ, Adimora AA, Dahman B, Galadima H, Sabik LM. Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South. AIDS Care 2018; 30:1459-1468. [PMID: 29845878 PMCID: PMC6150812 DOI: 10.1080/09540121.2018.1476656] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Structural barriers to HIV care are particularly challenging in the US South, which has higher HIV diagnosis rates, poverty, uninsurance, HIV stigma, and rurality, and fewer comprehensive public health programs versus other US regions. Focusing on one structural barrier, we examined geographic accessibility to comprehensive, coordinated HIV care (HIVCCC) in the US South. We integrated publicly available data to study travel time to HIVCCC in 16 Southern states and District of Columbia. We geocoded HIVCCC service locations and estimated drive time between the population-weighted county centroid and closest HIVCCC facility. We evaluated drive time in aggregate, and by county-level HIV prevalence quintile, urbanicity, and race/ethnicity. Optimal drive time was ≤30 min, a common primary care accessibility threshold. We identified 228 service locations providing HIVCCC across 1422 Southern counties, with median drive time to care of 70 min (IQR 64 min). For 368 counties in the top HIV prevalence quintile, median drive time is 50 min (IQR 61 min), exceeding 60 min in over one-third of these counties. Among counties in the top HIV prevalence quintile, drive time to care is six-folder higher for rural versus super-urban counties. Counties in the top HIV prevalence quintiles for non-Hispanic Blacks and for Hispanics have >50% longer drive time to care versus for non-Hispanic Whites. Including another potential care source-publicly-funded health centers serving low-income populations-could double the number of high-HIV burden counties with drive time ≤30 min, representing nearly 35,000 additional people living with HIV with accessible HIVCCC. Geographic accessibility to HIVCCC is inadequate in the US South, even in high HIV burden areas, and geographic and racial/ethnic disparities exist. Structural factors, such as geographic accessibility to care, may drive disparities in health outcomes. Further research on programmatic policies, and evidence-based alternative HIV care delivery models improving access to care, is critical.
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Affiliation(s)
- April D. Kimmel
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Steven P. Masiano
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Rose S. Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Erika G. Martin
- Nelson A. Rockefeller Institute of Government, Albany, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs & Policy, University at Albany, Albany, USA
| | - Faye Z. Belgrave
- Department of Psychology, Virginia Commonwealth University, Richmond, USA
| | - Adaora A. Adimora
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
| | - Hadiza Galadima
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Center for Health Analytics and Discovery, Eastern Virginia Medical School, Norfolk, USA
| | - Lindsay M. Sabik
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, USA
- Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, USA
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18
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Terzian AS, Younes N, Greenberg AE, Opoku J, Hubbard J, Happ LP, Kumar P, Jones RR, Castel AD. Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression. AIDS Behav 2018; 22:3009-3023. [PMID: 29603112 DOI: 10.1007/s10461-018-2103-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.
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Affiliation(s)
- A S Terzian
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
| | - N Younes
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - J Opoku
- District of Columbia Department of Health, HIV/AIDS, Hepatitis, STD, and TB Administration, Washington, DC, USA
| | - J Hubbard
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - L P Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - P Kumar
- School of Medicine, Georgetown University, Washington, DC, USA
| | - R R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - A D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
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Ridgway JP, Almirol EA, Schmitt J, Schuble T, Schneider JA. Travel Time to Clinic but not Neighborhood Crime Rate is Associated with Retention in Care Among HIV-Positive Patients. AIDS Behav 2018; 22:3003-3008. [PMID: 29600423 PMCID: PMC6076870 DOI: 10.1007/s10461-018-2094-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Using geospatial analysis, we examined the relationship of distance between a patient's residence and clinic, travel time to clinic, and neighborhood violent crime rates with retention in care or viral suppression among people living with HIV (PLWH). For HIV-positive patients at a large urban clinic, we measured distance and travel time between home and clinic and violent crime rate within a two block radius of the travel route. Kruskal-Wallis rank sum was used to compare outcomes between groups. Over the observation period, 2008-2016, 219/602 (36%) patients were retained in care. Median distance from clinic was 3.6 (IQR 2.1-5.6) miles versus 3.9 (IQR 2.7-6.1) miles among those retained versus not retained in care, p = 0.06. Median travel time by car was 15.9 (IQR 9.6-22.9) versus 17.1 (IQR 12.0-24.6) minutes for those retained versus not retained, p = 0.04. Violent crime rate along travel route was not associated with retention. There was no significant association between travel time or distance and viral suppression.
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Affiliation(s)
- Jessica P Ridgway
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, 60637, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Ellen A Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jessica Schmitt
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, 60637, Chicago, IL, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Todd Schuble
- Research Computing Center, University of Chicago, Chicago, IL, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 5065, 60637, Chicago, IL, USA.
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA.
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA.
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20
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Rudolph A, Tobin K, Rudolph J, Latkin C. Web-Based Survey Application to Collect Contextually Relevant Geographic Data With Exposure Times: Application Development and Feasibility Testing. JMIR Public Health Surveill 2018; 4:e12. [PMID: 29351899 PMCID: PMC5797287 DOI: 10.2196/publichealth.8581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/03/2017] [Indexed: 11/16/2022] Open
Abstract
Background Although studies that characterize the risk environment by linking contextual factors with individual-level data have advanced infectious disease and substance use research, there are opportunities to refine how we define relevant neighborhood exposures; this can in turn reduce the potential for exposure misclassification. For example, for those who do not inject at home, injection risk behaviors may be more influenced by the environment where they inject than where they live. Similarly, among those who spend more time away from home, a measure that accounts for different neighborhood exposures by weighting each unique location proportional to the percentage of time spent there may be more correlated with health behaviors than one’s residential environment. Objective This study aimed to develop a Web-based application that interacts with Google Maps application program interfaces (APIs) to collect contextually relevant locations and the amount of time spent in each. Our analysis examined the extent of overlap across different location types and compared different approaches for classifying neighborhood exposure. Methods Between May 2014 and March 2017, 547 participants enrolled in a Baltimore HIV care and prevention study completed an interviewer-administered Web-based survey that collected information about where participants were recruited, worked, lived, socialized, injected drugs, and spent most of their time. For each location, participants gave an address or intersection which they confirmed using Google Map and Street views. Geographic coordinates (and hours spent in each location) were joined to neighborhood indicators by Community Statistical Area (CSA). We computed a weighted exposure based on the proportion of time spent in each unique location. We compared neighborhood exposures based on each of the different location types with one another and the weighted exposure using analysis of variance with Bonferroni corrections to account for multiple comparisons. Results Participants reported spending the most time at home, followed by the location where they injected drugs. Injection locations overlapped most frequently with locations where people reported socializing and living or sleeping. The least time was spent in the locations where participants reported earning money and being recruited for the study; these locations were also the least likely to overlap with other location types. We observed statistically significant differences in neighborhood exposures according to the approach used. Overall, people reported earning money in higher-income neighborhoods and being recruited for the study and injecting in neighborhoods with more violent crime, abandoned houses, and poverty. Conclusions This analysis revealed statistically significant differences in neighborhood exposures when defined by different locations or weighted based on exposure time. Future analyses are needed to determine which exposure measures are most strongly associated with health and risk behaviors and to explore whether associations between individual-level behaviors and neighborhood exposures are modified by exposure times.
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Affiliation(s)
- Abby Rudolph
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Karin Tobin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
| | | | - Carl Latkin
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, United States
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21
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Place-Based Predictors of HIV Viral Suppression and Durable Suppression Among Men Who Have Sex With Men in New York City. AIDS Behav 2017. [PMID: 28646370 DOI: 10.1007/s10461-017-1810-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We explore relationships between place characteristics and HIV viral suppression among HIV-positive men who have sex with men (MSM) in New York City (NYC). We conducted multilevel analyses to examine associations of United Hospital Fund (UHF)-level characteristics to individual-level suppression and durable suppression among MSM. Individual-level independent and dependent variables came from MSM in NYC's HIV surveillance registry who had been diagnosed in 2009-2013 (N = 7159). UHF-level covariates captured demographic composition, economic disadvantage, healthcare access, social disorder, and police stop and frisk rates. 56.89% of MSM achieved suppression; 35.49% achieved durable suppression. MSM in UHFs where 5-29% of residents were Black had a greater likelihood of suppression (reference: ≥30% Black; adjusted relative risk (ARR) = 1.07, p = 0.04). MSM in UHFs with <30 MSM-headed households/10,000 households had a lower likelihood of achieving durable suppression (reference: ≥60 MSM-headed households/10,000; ARR = 0.82; p = 0.05). Place characteristics may influence viral suppression. Longitudinal research should confirm these associations.
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22
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Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression. J Acquir Immune Defic Syndr 2015; 69 Suppl 1:S37-43. [PMID: 25867777 DOI: 10.1097/qai.0000000000000587] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots. METHODS Retrospective cohort of 1404 persons newly diagnosed with HIV in 2008-2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention-in-care and residence in a hotspot associated with poor viral suppression. RESULTS In total, 24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared with 40.4% of those residing outside hotspots (P < 0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared with 75.3% of those outside hotspots (P < 0.0.05). Factors significantly associated with residence in poor retention hotspots included female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in poor viral suppression hotspots included female sex, higher economic deprivation, and shorter distance to pharmacies. CONCLUSIONS Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention-in-care and viral suppression.
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