Access to Federally Qualified Health Centers and HIV Outcomes in the U.S. South

Abstract

IntroductionFederally Qualified Health Centers (FQHCs) may increase access to HIV prevention, care, and treatment for at-risk populations. MethodsA pooled cross-section of Zip Code Tabulation Areas (ZCTAs) from cites in the US South with high HIV diagnoses were used to examine FQHC density and indicators of HIV epidemic control. The explanatory variable was FQHC density – number of FQHCs in a ZCTA's Primary Care Service Area (PCSA) per low-income population – high vs. medium/low (2019). Outcomes were 5-year (2015-2019 or 2014-2018) 1) number of new HIV diagnoses, 2) percent late diagnosis, 3) percent linked to care, and 4) percent virally suppressed, which was assessed over 1-year (2018 or 2019). Multiple linear regression was used to examine the relationship, including ZCTA-level sociodemographic and city-level HIV funding variables with state fixed-effects, and data analysis was completed in 2022-2023. Sensitivity analyses included examining, 1) ZCTAs with fewer non-FQHC primary care providers (PCPs), 2) controlling for county-level PCP-density, 3) excluding highest HIV prevalence ZCTAs, and 4) excluding Florida ZCTAs. ResultsHigh density ZCTAs had lower percent late diagnosis and virally suppressed, higher percent linked to care, and no differences in new HIV diagnoses (p<0.05). In adjusted analysis, high, compared to medium/low, density was associated with greater number new diagnoses (number or percent, 5.65; 95% Confidence Interval, 2.81, 8.49), lower percent late diagnosis (-3.71%; -5.99, -1.42), higher percent linked to care (2.13%; 0.20, 4.06), and higher percent virally suppressed (1.87%; 0.53, 2.74). ConclusionsResults suggest access to FQHCs may benefit community-level HIV epidemic indicators.