Individual, community, and structural factors associated with linkage to HIV care among people diagnosed with HIV in Tennessee.
Individual, community, and structural factors associated with linkage to HIV care among people diagnosed with HIV in Tennessee.
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DOI：
10.1371/journal.pone.0264508
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Wester C
中科院分区：
文献类型：
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作者：
Ahonkhai AA;Rebeiro PF;Jenkins CA;Rickles M;Cook M;Conserve DF;Pierce LJ;Shepherd BE;Brantley M;Wester C
我们评估了与田纳西州(田纳西州)艾滋病毒护理的个人联系有关的趋势，并确定了与个人和县级因素相关的因素。2012-2016年间被诊断感染艾滋病毒的TN居民被纳入分析(n=3751)。根据诊断时居住的县，个人被分配了县级因素。通过HIV诊断后的第一个CD4或HIV RNA检测日期来确定关联。我们使用改进的泊松回归来估计个体水平的30天关联护理的概率，以及个体和县级因素对这一结果的贡献。男男性接触者(ARR 1.23，95%CI 0.98~1.55)和报告异性性行为危险因素的女性(ARR 1.39，95%CI 1.18~1.65)比异性恋男性更有可能在30天内接受护理。非西班牙裔黑人个体的连锁比白人个体差(ARR为0.77，95%CI为0.71-0.83)。县级精神不健康天数与连锁呈负相关(ARR0.63，95%CI：0.40~0.99)。即使根据县级健康的社会决定因素进行调整，在个人和县一级，与保健挂钩的种族差异仍然存在。这些调查结果表明，需要采取结构性干预措施，既要解决结构性种族主义问题，又要解决心理健康问题，改善与护理的联系，尽量减少艾滋病毒结果中的种族差异。
We assessed trends and identified individual- and county-level factors associated with individual linkage to HIV care in Tennessee (TN). TN residents diagnosed with HIV from 2012–2016 were included in the analysis (n = 3,751). Individuals were assigned county-level factors based on county of residence at the time of diagnosis. Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used modified Poisson regression to estimate probability of 30-day linkage to care at the individual-level and the contribution of individual and county-level factors to this outcome. Both MSM (aRR 1.23, 95%CI 0.98–1.55) and women who reported heterosexual sex risk factors (aRR 1.39, 95%CI 1.18–1.65) were more likely to link to care within 30-days than heterosexual males. Non-Hispanic Black individuals had poorer linkage than White individuals (aRR 0.77, 95%CI 0.71–0.83). County-level mentally unhealthy days were negatively associated with linkage (aRR 0.63, 95%CI: 0.40–0.99). Racial disparities in linkage to care persist at both individual and county levels, even when adjusting for county-level social determinants of health. These findings suggest a need for structural interventions to address both structural racism and mental health needs to improve linkage to care and minimize racial disparities in HIV outcomes.
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DOI：
10.1097/qai.0000000000001134
发表时间：
2017-01-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Pilcher CD;Ospina-Norvell C;Dasgupta A;Jones D;Hartogensis W;Torres S;Calderon F;Demicco E;Geng E;Gandhi M;Havlir DV;Hatano H
通讯作者：
Hatano H
影响因子：
12.7
作者：
Krieger, N;Chen, JT;Subramanian, SV
通讯作者：
Subramanian, SV
影响因子：
3.8
作者：
Senn, Theresa E.;Walsh, Jennifer L.;Carey, Michael P.
通讯作者：
Carey, Michael P.
影响因子：
1.4
作者：
Trepka MJ;Sheehan DM;Fennie KP;Mauck DE;Lieb S;Maddox LM;Niyonsenga T
通讯作者：
Niyonsenga T
影响因子：
11.8
作者：
Rickles, Michael;Rebeiro, Peter F.;McPheeters, Melissa
通讯作者：
McPheeters, Melissa