1
|
Patel D, Clark HA, Williams WO, Taylor-Aidoo N, Wright C. CDC-Funded HIV Testing Services Outcomes and Social Determinants of Health in Ending the HIV Epidemic in the U.S. Jurisdictions. AIDS Behav 2024; 28:1152-1165. [PMID: 37479920 PMCID: PMC10799961 DOI: 10.1007/s10461-023-04133-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 07/23/2023]
Abstract
We performed an ecological analysis to examine associations between CDC-funded HIV testing services outcomes and social determinants of health (SDOH) among Ending the HIV Epidemic in the U.S. jurisdictions. Using National HIV Prevention Program Monitoring & Evaluation (2020) and American Community Survey (2016-2020) data, we ran robust Poisson models (adjusted for race/ethnicity). In healthcare settings, a 10% absolute increase in percentage without health insurance was associated with a 40% lower prevalence of newly diagnosed positivity (aPR = 0.60, 95% CI: 0.43-0.83); a $5,000 increase in median household income (aPR = 1.04, 95% CI: 1.03-1.06) and a 10% absolute increase in percentage unemployed (aPR = 1.80, 95% CI: 1.31-2.46) were associated with 4% and 80%, respectively, higher prevalence of percentage linked to HIV medical care within 30 days of diagnosis (i.e., linkage). In non-healthcare settings, a 10% absolute increase in percentage with less than high school diploma (aPR = 0.53, 95% CI: 0.29-0.96) was associated with a 47% lower prevalence of newly diagnosed positivity, whereas a 10% absolute increase in percentage without health insurance (aPR = 1.92, 95% CI: 1.29-2.88) was associated with a 92% higher prevalence of newly diagnosed positivity; a 10% absolute increase in percentage with less than high school diploma was associated with a 35% lower prevalence of linkage (aPR = 0.65, 95% CI: 0.43-0.97). Addressing SDOH in HIV prevention programs will play an important role in ending the HIV epidemic.
Collapse
Affiliation(s)
- Deesha Patel
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA, 30329, USA.
| | - Hollie A Clark
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Weston O Williams
- Public Health Analytic Consulting Services, Inc, Hillsborough, NC, USA
| | - Nicole Taylor-Aidoo
- Keymind, A Division of Axiom Resource Management, Inc, Falls Church, VA, USA
| | - Carolyn Wright
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS H24-5, Atlanta, GA, 30329, USA
| |
Collapse
|
2
|
Kimaru LJ, Habila MA, Mantina NM, Madhivanan P, Connick E, Ernst K, Ehiri J. Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002870. [PMID: 38349915 PMCID: PMC10863897 DOI: 10.1371/journal.pgph.0002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
Collapse
Affiliation(s)
- Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Magdiel A. Habila
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - Namoonga M. Mantina
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth Connick
- Department of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Kacey Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - John Ehiri
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| |
Collapse
|
3
|
Chang HY, Johnson V, Conyers LM. Exploring the Impact of an Integrated Trauma-Informed HIV and Vocational Intervention for Black/African American Women Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6649. [PMID: 37681789 PMCID: PMC10487101 DOI: 10.3390/ijerph20176649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023]
Abstract
Given the increased recognition of the role of social determinants of health on the prevalence of HIV in the United States, interventions that incorporate and address social determinants of HIV are essential. In response to the health disparities facing Black/African American women living with HIV, HIV activists and mental health specialists developed an innovative integrated HIV prevention and vocational development intervention, Common Threads, that underscores and addresses key economic and other social determinants of health experienced by Black/African American women within a trauma-informed care (TIC) framework. This research study applied grounded theory methods to conduct a qualitative study of Common Threads based on interviews with 21 women who participated in the Common Threads intervention. Participants shared several critical aspects of program components that reflected the TIC principles, endorsing a safe environment, trust building, and a sense of belonging. These components also encouraged transparency and promoted autonomy. Additionally, participants shared perceived program outcomes, including changes of knowledge and skills in four considering work domains (i.e., medical, psychosocial financial/legal resources, and vocational) that facilitate health and vocational development.
Collapse
Affiliation(s)
- Hsiao-Ying Chang
- Yang-Tan Institute on Employment and Disability, Cornell University, Ithaca, NY 14850, USA
| | - Vanessa Johnson
- Ribbon, Suite 200, 1300 Mercantile Lane, Largo, MD 20774, USA;
| | - Liza Marie Conyers
- Educational Psychology, Counseling, and Special Education, Pennsylvania State University, University Park, PA 16802, USA;
| |
Collapse
|
4
|
Beltran RM, Holloway IW, Hong C, Miyashita A, Cordero L, Wu E, Burris K, Frew PM. Social Determinants of Disease: HIV and COVID-19 Experiences. Curr HIV/AIDS Rep 2022; 19:101-112. [PMID: 35107810 PMCID: PMC8808274 DOI: 10.1007/s11904-021-00595-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The differential impact of the COVID-19 and HIV pandemics on marginalized communities has renewed calls for more robust and deeper investigation into structural and social causes of health inequities contributing to these infections, including underlying factors related to systematic racism. Using the Social Determinants of Health (SDOH) framework, we analyzed parallel and divergent factors associated with COVID-19 and HIV/AIDS and the prevalence of disparate disease in diverse communities. We utilized PRISMA guidelines to identify relevant literature (N = 210 articles) that resulted in a review of 125 articles included in our synthesis. RECENT FINDINGS With racial health inequities as a core contributor to disease vulnerability, we also identified other factors such as economic stability, social and community support, the neighborhood and built environment, healthcare access and quality, and education access and quality as important socioecological considerations toward achieving health equity. Our review identifies structural and systematic factors that drive HIV and COVID-19 transmission. Our review highlights the importance of not solely focusing on biomedical interventions as solutions to ending HIV and COVID-19, but rather call for building a more just public health and social service safety net that meets the needs of people at the intersection of multiple vulnerabilities.
Collapse
Affiliation(s)
- Raiza M Beltran
- David Geffen School of Medicine, Department of Infectious Diseases, UCLA Global HIV Prevention Research Program, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA.
| | - Ian W Holloway
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Chenglin Hong
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Ayako Miyashita
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
| | - Luisita Cordero
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
| | - Elizabeth Wu
- UCLA Hub for Health Intervention, Policy and Practice (HHIPP), CA, Los Angeles, USA
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, Los Angeles, CA, USA
- California HIV/AIDS Research Program, Los Angeles, CA, USA
| | - Katherine Burris
- UNLV School of Public Health, UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| | - Paula M Frew
- UNLV School of Public Health, UNLV Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
| |
Collapse
|
5
|
Durstenfeld MS, Hsue PY. Mechanisms and primary prevention of atherosclerotic cardiovascular disease among people living with HIV. Curr Opin HIV AIDS 2021; 16:177-185. [PMID: 33843806 PMCID: PMC8064238 DOI: 10.1097/coh.0000000000000681] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW To highlight mechanisms of elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLWH), discuss therapeutic strategies, and opportunities for primary prevention. RECENT FINDINGS HIV-associated ASCVD risk is likely multifactorial and due to HIV-specific factors and traditional risk factors even in the setting of treated and suppressed HIV disease. Although a growing body of evidence suggests that inflammation and immune activation are key drivers of atherogenesis, therapies designed to lower inflammation including colchicine and low-dose methotrexate have not improved secondary cardiovascular endpoints among PLWH. Statins continue to be the mainstay of management of hyperlipidemia in HIV, but the impact of newer lipid therapies including proprotein convertase subtilisin/kexin type 9 inhibitors on ASCVD risk among PLWH is under investigation. Aside from the factors mentioned above, healthcare disparities are particularly prominent among PLWH and thus likely contribute to increased ASCVD risk. SUMMARY Our understanding of mechanisms of elevated ASCVD risk in HIV continues to evolve, and the optimal treatment for CVD in HIV aside from targeting traditional risk factors remains unknown. Future studies including novel therapies to lower inflammation, control of risk factors, and implementation science are needed to ascertain optimal ways to treat and prevent ASCVD among PLWH.
Collapse
Affiliation(s)
- Matthew S Durstenfeld
- Division of Cardiology, UCSF at Zuckerberg San Francisco General Hospital
- Department of Medicine, University of California, San Francisco, California, USA
| | - Priscilla Y Hsue
- Division of Cardiology, UCSF at Zuckerberg San Francisco General Hospital
- Department of Medicine, University of California, San Francisco, California, USA
| |
Collapse
|