Examining the effects of neighborhood factors and geography on racial/ethnic disparities on achieving sustained viral suppression

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Project Summary/Abstract The risk of HIV transmission and disease progression to AIDS decreases among people living with HIV (PLHIV) that have achieved viral suppression. Prior studies have measured the last viral load in a year to assess viral suppression. However, this single measurement only provides viral suppression status at a single point in time and does not indicate sustained viral suppression throughout a year (all viral load tests within a year <200 copies/mL). Particularly, PLHIV belonging to racial/ethnic minority groups are challenged by barriers to achieving and maintaining viral suppression. Some of these barriers are related to physical and social neighborhood factors such as living in economically deprived neighborhoods. There has been little research to date about the role of neighborhood factors in achieving sustained viral suppression. Therefore, the objective of this F31 study is to assess the contribution of neighborhood, geographic and distance factors on racial/ethnic disparities in sustained viral suppression. To address this objective, secondary data analysis will be conducted using administrative data from the Miami-Dade County Ryan White HIV/AIDS Program, which provides HIV care and treatment to approximately 9,600 underserved and uninsured minority PLHIV. This proposed research study aims to (1) identify individual and neighborhood level factors that are associated with residing in geographic hotspots of low sustained viral suppression, (2) identify the moderating effect of neighborhood disadvantage on the association between race/ethnicity and sustained viral suppression, and (3) examine the moderating effect of race/ethnicity on the association between sustained viral suppression and travel time and distance to HIV case management sites and AIDS Drug Assistance Program pharmacies. The central hypothesis is that neighborhood disadvantage and distance to HIV care facility will contribute to racial/ethnic disparities in achieving sustained viral suppression. The proposed study will use multi-level mixed effects modeling to estimate the association between individual and neighborhood factors and sustained viral suppression and geographic information system tools to identify hotspots of sustained viral suppression and to determine travel time and distance to HIV care facilities. In order to successfully implement this proposed study and launch the research career of a young minority investigator, training in the following 5 areas are proposed: (1) HIV care and treatment disparities, (2) neighborhood and geographic determinants of HIV disparities, (3) multilevel mixed modeling, (4) spatial statistics, and (5) responsible conduct of research and professional development (grant and scientific writing). This study and training experience will facilitate the applicant’s development towards becoming an independent health disparities researcher and provide essential skills to help her successfully compete for a post-doctoral grant or an early career development grant funding. Furthermore, findings from this study will identify neighborhood, geographic, and distance factors that may be targeted to ensure consistent and long-term viral load suppression for vulnerable PLHIV.