Patterns and predictors of racial/ethnic disparities in HIV care continuum in the South

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Project Summary/Abstract The HIV care continuum (HCC), a compelling framework to describe the current clinical goals for managing HIV infection, tracks the progression of people living with HIV (PLWH) from diagnosis, through linkage to care, retention in care, and ultimately to the goal of viral suppression. Unfortunately, health disparities exist at every step of the continuum among racial/ethnic minority population. Such racial/ethnic disparities may have significantly delayed the progress in HCC in the Southern US states that are strongly represented among geographic focus areas in the 2019 federal initiative titled “Ending the HIV Epidemic: A Plan for America” (EtHE). Given the unabated high levels of segregation over time in some areas of the South, it is critical to identifying drivers of health disparities in HCC outcomes and advance health equity and improve population health. A singular focus on individual-level strategies to improve health and ameliorate health disparities has been reported ineffective. Recognition of the impact of social factors, which have been coined as fundamental causes of racial/ethnic health disparities because of their role in shaping other myriad factors important for promoting health equities, has prompted a global shift in focus away from simply addressing symptoms and conditions to also considering patient social needs and lived experiences in assessment and treatment. However, limited efforts have been made to quantify the long-term spatiotemporal variations of HCC disparities and their contributing factors over time, particularly in the context of COVID-19 pandemic. With NIH support (R01AI127203) since 2017, we have been utilizing a Big Data approach to examine treatment gaps among PLWH in South Carolina (SC). The ongoing research extracted and linked longitudinal EHR data from six state agencies. The cohort in the existing project include all PLWH who were diagnosed through December 2020 in SC. To address the gaps in HCC-related health disparity research, we will leverage the exiting data from R01AI127203 project and link these data to aggregated community and social structural level data (e.g., structural racism, COVID-19 pandemic) from multiple publicly available data sources. Beyond the scope of original project, we will first identify the spatiotemporal patterns of racial disparities (e.g., exacerbating or attenuating trend) of each HCC outcome, then determine the contribution of contextual features for temporal change of disparities in HCC using the multivariable generalized regression with lasso penalty. The proposed research is innovative and significant because identifying and reducing racial/ethnic disparities in HCC outcomes is essential to understand the fundamental causes and evolving risk of poor HCC outcomes and achieve the EtHE goals in SC and other Southern states in the US. The research findings could inform state health department to promote social equality, motivate healthcare systems to address patients’ social needs as part of healthcare delivery, and devise more precise, targeted intervention strategies for socially disadvantaged areas to achieve the health equality and improve HIV treatment outcomes.