Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS

• Published in: AIDS and behavior Vol. 24; no. 10; pp. 2811 - 2818
• Main Authors: Chandran, Aruna, Edmonds, Andrew, Benning, Lorie, Wentz, Eryka, Adedimeji, Adebola, Wilson, Tracey E., Blair-Spence, Amanda, Palar, Kartika, Cohen, Mardge, Adimora, Adaora
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2020; Springer Nature B.V
• Subjects: Adult; Anti-Retroviral Agents - therapeutic use; Drugs; Educational attainment; Female; Female headed households; Health Psychology; HIV; HIV Infections - drug therapy; HIV Infections - psychology; Households; Housing; Human immunodeficiency virus; Humans; Infectious Diseases; Longitudinal Studies; Male; Medication Adherence; Medicine; Medicine & Public Health; Middle Aged; Neighborhoods; Original Paper; Ownership; Patient compliance; Poverty; Public Health; Residence Characteristics - statistics & numerical data; Social Determinants of Health; Socioeconomic Factors; Treatment Outcome; Unemployment; Viral Load; Adherence; HIV; WIHS; Neighborhood determinants; Care engagement
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-020-02830-4

Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes.