Latent class analysis of syndemic factors associated with HIV care outcomes among women living with HIV in the South

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Abstract - New strategies are needed to understand the interplay of multiple barriers to HIV care engagement and viral suppression for diverse women living with HIV in the South. The South is a high-risk geographic area, with more than half of the new HIV diagnoses in the U.S., and incidence rates unchanged in a decade. Across the South, low resources, economic disparities, and racial/ethnic dynamics present challenges to ending the HIV epidemic. While research to date has identified factors independently associated with HIV care outcomes for women, our study will examine the simultaneous interplay of factors among women living with HIV in the South, in order to prioritize targets for intervention across racial/ethnic groups. Thus, the overall objectives of the proposed research are to: (1) examine psychosocial, structural, and behavioral comorbidities associated with three key outcomes along the HIV care continuum: (a) HIV care engagement, (b) viral suppression, and (c) biobehavioral transmission risk (condomless sex in the context of unsuppressed viral load); and (2) and to identify whether unique combinations of these comorbidities form syndemics that vary by race/ethnicity. We propose a secondary analysis of 2015-2019 data from the Medical Monitoring Project, a population-based study of persons living with HIV, focused on six Southern states: FL, GA, NC, MS, TX, and VA (N=~2,082). We have two Specific Aims. Aim 1 will quantitatively assess racial/ethnic disparities in HIV care engagement, viral suppression, and biobehavioral transmission risk among women in the six Southern states by (a) describing proportions of each outcome among Hispanic, non-Hispanic Black, non-Hispanic White, and other/multiracial women; (b) estimating associations between race/ethnicity, psychosocial, structural, and behavioral factors, and the three key outcomes; and (c) testing whether race/ethnicity moderates the association between psychosocial, structural, and behavioral factors and each of the three outcomes. Aim 2 will assess syndemic conditions experienced by women of different racial/ethnic groups by: (a) conducting latent class analyses to identify unique combinations of social and structural factors that may form a syndemic and that may vary by race/ethnicity, and (b) using regression analyses to test whether these emergent latent classes predict the three outcomes along the HIV Care Continuum. This R15 AREA study will strengthen the research environment by growing research mentorship, an academic-community network of collaborators, and a pipeline for quantitative research in health inequities and HIV at UNCG and will provide opportunities for active research involvement for undergraduate students with structured, collaborative mentorship throughout the project. Ultimately, this R15 AREA study will foster the development of evidence-based strategies to improve HIV care continuum outcomes by providing the foundational data to prioritize intervention strategies to address combinations of barriers experienced by diverse women in the South. Future clinical trials will test these potential interventions.