Understanding Local Spatial Variation Along the Care Continuum
- 1 May 2016
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in JAIDS Journal of Acquired Immune Deficiency Syndromes
- Vol. 72 (1), 65-72
- https://doi.org/10.1097/qai.0000000000000914
Abstract
Background: Engagement in care is central to reducing mortality for HIV-infected persons and achieving the White House National AIDS Strategy of 80% viral suppression in the US by 2020. Where an HIV-infected person lives impacts his or her ability to achieve viral suppression. Reliable transportation access for healthcare may be a key determinant of this place-suppression relationship. Methods: ZIP code tabulation areas (ZCTAs) were the units of analysis. We used geospatial and ecologic analyses to examine spatial distributions of neighborhood-level variables (eg, transportation accessibility) and associations with: (1) community linkage to care, and (2) community viral suppression. Among Atlanta ZCTAs with data for newly diagnosed HIV cases (2006–2010), we used Moran I to evaluate spatial clustering and linear regression models to evaluate associations between neighborhood variables and outcomes. Results: In 100 ZCTAs with 8413 newly diagnosed HIV-positive residents, a median of 60 HIV cases were diagnosed per ZCTA during the 5-year period. We found significant clustering of ZCTAs with low linkage to care and viral suppression (Moran I = 0.218, P < 0.05). In high-poverty ZCTAs, a 10% point increase in ZCTA-level household vehicle ownership was associated with a 4% point increase in linkage to care (P = 0.02, R2 = 0.16). In low-poverty ZCTAs, a 10% point increase in ZCTA-level household vehicle ownership was associated with a 30% point increase in ZCTA-level viral suppression (P = 0.01, R2 = 0.08). Conclusions: Correlations between transportation variables and community-level care linkage and viral suppression vary by area poverty level and provide opportunities for interventions beyond individual-level factors.Keywords
This publication has 16 references indexed in Scilit:
- Individual and Community Factors Associated With Geographic Clusters of Poor HIV Care Retention and Poor Viral SuppressionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2015
- Spatial Accessibility to HIV Providers in Atlanta, GeorgiaAIDS Research and Human Retroviruses, 2015
- Human Immunodeficiency Virus Transmission at Each Step of the Care Continuum in the United StatesJAMA Internal Medicine, 2015
- Behind the CascadeJAIDS Journal of Acquired Immune Deficiency Syndromes, 2013
- Geographic Information System-based Screening for TB, HIV, and Syphilis (GIS-THIS): A Cross-Sectional StudyPLOS ONE, 2012
- Prevalence of Transmitted Antiretroviral Drug Resistance Differs Between Acutely and Chronically HIV-Infected PatientsJAIDS Journal of Acquired Immune Deficiency Syndromes, 2012
- Phylogenetic insights into regional HIV transmissionAIDS, 2012
- Early Retention in HIV Care and Viral Load SuppressionJAIDS Journal of Acquired Immune Deficiency Syndromes, 2012
- Prevention of HIV-1 Infection with Early Antiretroviral TherapyThe New England Journal of Medicine, 2011
- Missed Visits and Mortality among Patients Establishing Initial Outpatient HIV TreatmentClinical Infectious Diseases, 2009