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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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Hoenigl M, Lo M, Coyne CJ, Wagner GA, Blumenthal J, Mathur K, Horton LE, Martin TC, Vilke GM, Little SJ. 4th Generation HIV screening in the emergency department: net profit or loss for hospitals? AIDS Care 2023; 35:714-718. [PMID: 34839750 PMCID: PMC9135954 DOI: 10.1080/09540121.2021.1995838] [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: 11/02/2020] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
ABSTRACTThe objective of this study was to determine hospital costs and revenue of universal opt-out HIV ED screening. An electronic medical record (EMR)-directed, automated ED screening program was instituted at an academic medical center in San Diego, California. A base model calculated net income in US dollars for the hospital by comparing annual testing costs with reimbursements using payor mixes and cost variables. To account for differences in payor mixes, testing costs, and reimbursement rates across hospitals in the US, we performed a probabilistic sensitivity analysis. The base model included a total of 12,513 annual 4th generation HIV tests with the following payor mix: 18% Medicare, 9% MediCal, 28% commercial and 8% self-payers, with the remainder being capitated contracts. The base model resulted in a net profit for the hospital. In the probabilistic sensitivity analysis, universal 4th generation HIV screening resulted in a net profit for the hospital in 81.9% of simulations. Universal 4th generation opt-out HIV screening in EDs resulted in a net profit to an academic hospital. Sensitivity analysis indicated that ED HIV screening results in a net-profit for the majority of simulations, with higher proportions of self-payers being the major predictor of a net loss.
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Affiliation(s)
- Martin Hoenigl
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
- Department of Pathology, University of California San Diego, San Diego, California, United States
- Division of Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Megan Lo
- School of Medicine, University of San Diego, San Diego, California, United States
| | - Christopher J. Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Gabriel A. Wagner
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Jill Blumenthal
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Kushagra Mathur
- School of Medicine, University of San Diego, San Diego, California, United States
| | - Lucy E. Horton
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Thomas C.S. Martin
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
| | - Gary M. Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, California, United States
| | - Susan J. Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, United States
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Lara-Paez G, Zuazo M, Blumenthal J, Coyne CJ, Hoenigl M. HIV and Hepatitis C Virus Screening in the Emergency Department and Linkage to Care During COVID-19: Challenges and Solutions. J Acquir Immune Defic Syndr 2021; 88:e14-e16. [PMID: 34267055 PMCID: PMC8425513 DOI: 10.1097/qai.0000000000002763] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- George Lara-Paez
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
| | - Miriam Zuazo
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
| | - Jill Blumenthal
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
| | - Christopher J Coyne
- Department of Emergency Medicine, University of California San Diego, San Diego, CA
| | - Martin Hoenigl
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA
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Vrancken B, Mehta SR, Ávila-Ríos S, García-Morales C, Tapia-Trejo D, Reyes-Terán G, Navarro-Álvarez S, Little SJ, Hoenigl M, Pines HA, Patterson T, Strathdee SA, Smith DM, Dellicour S, Chaillon A. Dynamics and Dispersal of Local HIV Epidemics Within San Diego and Across The San Diego-Tijuana Border. Clin Infect Dis 2020; 73:e2018-e2025. [PMID: 33079188 DOI: 10.1093/cid/ciaa1588] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Evolutionary analyses of well-annotated HIV sequence data can provide insights into viral transmission patterns and associated factors. Here, we explored the transmission dynamics of the HIV-1 subtype B epidemic across the San Diego (US) - Tijuana (Mexico) border region to identify factors that could help guide public health policy. METHODS HIV pol sequences were collected from people with HIV in San Diego County and from Tijuana between 1996-2018. A multistep phylogenetic approach was used to characterize the dynamics of spread. The contribution of geospatial factors and HIV risk group to the local dynamics were evaluated. RESULTS Phylogeographic analyses of the 2,034 sequences revealed an important contribution of local transmission in sustaining the epidemic, as well as a complex viral migration network across the region. Geospatial viral dispersal between San Diego communities occurred predominantly among men-who-have-sex with-men with central San Diego being the main source (34.9%) and recipient (39.5%) of migration events. HIV migration was more frequent from San Diego county towards Tijuana than vice versa. Migrations were best explained by driving time between locations. CONCLUSION The US-Mexico border may not be a major barrier to the spread of HIV, which may stimulate coordinated transnational intervention approaches. Whereas a focus on central San Diego has the potential to avert most spread, the substantial viral migration independent of central San Diego shows that county-wide efforts will be more effective. Combined, this work shows that epidemiological information gleaned from pathogen genomes can uncover mechanisms that underlie sustained spread and, in turn, can be a building block of public health decision making.
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Affiliation(s)
- Bram Vrancken
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Computational and Evolutionary Virology, KU Leuven, Herestraat, Leuven, Belgium
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan, Colonia Sección XVI, CP, Mexico City, Mexico
| | - Claudia García-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan, Colonia Sección XVI, CP, Mexico City, Mexico
| | - Daniela Tapia-Trejo
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan, Colonia Sección XVI, CP, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Coordinating Commission of the Mexican National Institutes of Health, Periférico Sur, Arenal Tepepan, Mexico City, Mexico
| | | | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Heather A Pines
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Thomas Patterson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Simon Dellicour
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Computational and Evolutionary Virology, KU Leuven, Herestraat, Leuven, Belgium.,Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, av. FD Roosevelt, Bruxelles, Belgium
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
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