Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS
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ORIGINAL PAPER
Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS Aruna Chandran1 · Andrew Edmonds2 · Lorie Benning1 · Eryka Wentz1 · Adebola Adedimeji3 · Tracey E. Wilson4 · Amanda Blair‑Spence5 · Kartika Palar6 · Mardge Cohen7 · Adaora Adimora2
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Neighborhood determinants · HIV · Adherence · Care engagement · WIHS Resumen La identificación de los determinantes estructurales que afectan los resultados del VIH es importante para informar las intervenciones en geografías heterogéneas. Se utilizaron modelos longitudinales jerárquicos generalizados de efectos mixtos para cuantificar las asociaciones entre los cambios en ciertos factores de nivel estructural en el compromiso con los cuidados del * Aruna Chandran [email protected] 1
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, #W6501, Baltimore, MD 21205, USA
2
Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
3
Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
4
Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
5
Division of Infectious Disease and Travel Medicine, Department of Medicine, Georgetown University, Washington, DC, USA
6
Division of HIV, Infectious Disease and Global Medicine, School of Medicine, University of California, San Francisco, CA, USA
7
Cook County Health and Hospital System, Chicago, IL, USA
13
Vol.:(0123456789)
AIDS and Behavior
VIH, la adherencia a la medicación y la supresión viral. Entre las mujeres que viven con el VIH en el WIHS, los aumentos de diez unidades en la proporción de desempleo, pobreza y falta de p
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