Open AccessLongitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS
Author(s) -
Aruna Chandran,
Andrew Edmonds,
Lorie Benning,
Eryka L. Wentz,
Adebola Adedimeji,
Tracey E. Wilson,
Amanda Blair-Spence,
Kartika Palar,
Mardge H. Cohen,
Adaora A. Adimora
Publication year - 2020
Publication title -
aids and behavior
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.994
H-Index - 106
eISSN - 1573-3254
pISSN - 1090-7165
DOI - 10.1007/s10461-020-02830-4
Subject(s) - health psychology , unemployment , context (archaeology) , human immunodeficiency virus (hiv) , multilevel model , demography , psychological intervention , poverty , public health , educational attainment , census tract , medicine , longitudinal study , psychology , gerontology , socioeconomic status , sociology , geography , immunology , population , economics , psychiatry , economic growth , nursing , archaeology , pathology , machine learning , computer science
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.