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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.
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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
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Kerr J, Smith A, Nzama N, Bullock NAA, Chandler C, Osezua V, Johnson K, Rozema I, Metzger IW, Harris LM, Bond K, LaPreze D, Rice BM. Systematic Review of Neighborhood Factors Impacting HIV Care Continuum Participation in the United States. J Urban Health 2024; 101:31-63. [PMID: 38093034 PMCID: PMC10897076 DOI: 10.1007/s11524-023-00801-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 01/07/2024]
Abstract
Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.
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Affiliation(s)
- Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
| | - Adrienne Smith
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nqobile Nzama
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Nana Ama Aya Bullock
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA
| | - Cristian Chandler
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Victory Osezua
- Public Health Program, Gwynedd Mercy University, Gwynedd Valley, PA, USA
| | - Karen Johnson
- School of Social Work, University of Alabama, Tuscaloosa, AL, USA
| | - Isabel Rozema
- University of Louisville Health, Louisville, KY, USA
| | - Isha W Metzger
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Lesley M Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Keosha Bond
- Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY, USA
| | - Dani LaPreze
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY, USA
| | - Bridgette M Rice
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA, USA
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Montano-Campos JF, Stout JE, Pettit AC, Okeke NL. Association of Neighborhood Deprivation With Healthcare Utilization Among Persons With Human Immunodeficiency Virus: A Latent Class Analysis. Open Forum Infect Dis 2023; 10:ofad317. [PMID: 37426949 PMCID: PMC10326676 DOI: 10.1093/ofid/ofad317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/11/2023] [Indexed: 07/11/2023] Open
Abstract
Background We previously identified 3 latent classes of healthcare utilization among people with human immunodeficiency virus (PWH): adherent, nonadherent, and sick. Although membership in the "nonadherent" group was associated with subsequent disengagement from human immunodeficiency virus (HIV) care, socioeconomic predictors of class membership remain unexplored. Methods We validated our healthcare utilization-based latent class model of PWH receiving care at Duke University (Durham, North Carolina) using patient-level data from 2015 to 2018. SDI scores were assigned to cohort members based on residential addresses. Associations of patient-level covariates with class membership were estimated using multivariable logistic regression and movement between classes was estimated using latent transition analysis. Results A total of 1443 unique patients (median age of 50 years, 28% female sex at birth, 57% Black) were included in the analysis. PWH in the most disadvantaged (highest) SDI decile were more likely to be in the "nonadherent" class than the remainder of the cohort (odds ratio [OR], 1.58 [95% confidence interval {CI}, .95-2.63]) and were significantly more likely to be in the "sick" class (OR, 2.65 [95% CI, 2.13-3.30]). PWH in the highest SDI decile were also more likely to transition into and less likely to transition out of the "sick" class. Conclusions PWH who resided in neighborhoods with high levels of social deprivation were more likely to have latent class membership in suboptimal healthcare utilization groupings, and membership persisted over time. Risk stratification models based on healthcare utilization may be useful tools in the early identification of persons at risk for suboptimal HIV care engagement.
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Affiliation(s)
- J Felipe Montano-Campos
- Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Jason E Stout
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
| | - April C Pettit
- Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nwora Lance Okeke
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina, USA
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Khumalo GE, Ntuli S, Lutge E, Mashamba-Thompson TP. Geo-analysis: the distribution of community health workers in relation to the HIV prevalence in KwaZulu-Natal province, South Africa. BMC Health Serv Res 2022; 22:326. [PMID: 35277152 PMCID: PMC8915516 DOI: 10.1186/s12913-022-07707-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/28/2022] [Indexed: 11/21/2022] Open
Abstract
Background The South African Ward Based Primary Health Care Outreach Team (WBPHCOT) policy framework states that the distribution of community health workers (CHWs) should be proportional to levels of poverty and disease within the population. We aimed to describe the spatial distribution of CHWs in relation to the prevalence of the Human Immunodeficiency Virus (HIV) which has itself been associated with poverty in previous studies. Methods This was a descriptive, cross-sectional study in which secondary data was used for geospatial analysis. Based on the extrapolation from the norm of one WBPHCOT per 6000 individuals, we utilized geographic information system (GIS) methods to visualize the distribution of CHWs in relation to the prevalence of HIV in KwaZulu-Natal (KZN). Dot density mapping was used to visualize the random distribution of CHWs in relation to HIV prevalence and population in the districts. The districts’ HIV prevalence, number of PLWH, ratio of CHW: people living with HIV (PLWH), ratio of CHW: population and poverty scores were mapped using choropleth mapping. MapInfo Pro 17.0 was used to map geospatial presentation of the data. Results Overall, KZN province showed under allocation of CHWs with a CHW: people ratio of 1: 1156 compared to the estimated norm of 1: 600–1000. At district level, only two of 11 districts met the suggested norm of CHW: PLWH (1: 109–181). This indicates shortages and misallocation of CHWs in the nine remaining districts. Furthermore, our findings showed extensive geospatial heterogeneity with no clear pattern in the distribution of CHWs. There was no relationship between CHW distribution and HIV prevalence or poverty scores in the districts. Conclusion This study shows inequality in the distribution of CHWs which may be associated with inequalities in the provision of HIV related services. It is critical to strengthen the response to the HIV epidemic through the appropriate distribution of CHWs especially in those districts with high levels of HIV prevalence and poverty.
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