Social Determinants of Health and Disparities in Linkage to Care Among Newly Diagnosed HIV Cases – South Carolina, 2009–2011

Abstract

BackgroundKey to improved HIV outcomes is early diagnosis, linkage to care (LTC), retention in care (RIC) and viral load (VL) suppression. As treatment for HIV has become more effective, the gap in racial disparities has widened for LTC, RIC and VL. Social determinants of health (SDH) are conditions such as poverty level, income, education, employment that are responsible for most health inequities. SDH are drivers of disparities in HIV prevalence. The objective of this study is to evaluate the impact of SDH on racial disparities on time to LTC for newly diagnosed HIV infected individuals in South Carolina (SC).MethodsData was obtained from the SC enhanced HIV/AIDS Reporting System. Analysis includes individuals diagnosed with HIV in SC from 2009–2011. LTC was calculated as the time from HIV diagnosis to first CD4 or VL test. Early LTC was defined as within 30 days. Late LTC was >30 to 365 days. Individuals not LTC by 365 days were considered to have never been linked to care (NLTC). Census tract data was used to determine SHD (poverty, education, income, and unemployment) based on residence at the time of HIV diagnosis. Descriptive analysis was performed on data from newly infected individuals. Factors potentially associated with late LTC and NLTC including patient demographics, behavioral risk, residence at diagnosis and SDH were investigated.ResultsFrom 2009–2011, 2151 individuals were newly diagnosed with HIV. Of these 1636 (76.1%) were LTC early, 285 (13.2%) were LTC late and 230 (10.7%) were NLTC. NLTC was associated with male gender, lower initial CD4 count, and earlier stage of HIV at time of diagnoses (P <0.01). In multivariable analysis early HIV stage at HIV diagnosis (aOR: 1.82; 95% CI 1.3, 2.5) and living in census tracts with lower income (aOR 0.65; 95% CI 0.44, 0.97) are associated with late LTC. Male gender (aOR 2.66; 95% CI 1.49, 4.76) unknown HIV risk group (aOR 2.03; 95% CI 1.11, 2.74) and early HIV stage at diagnosis (aOR 4.59; 95% CI 2.33, 9.04) are associated with NLTC.ConclusionIn SC, almost ¼ of newly diagnosed HIV infected individuals from 2009–2011 were LTC late or NLTC. SDH were not associated with late LTC or NLTC. Living in a low income census tract was associated with a lower risk for late LTC, possible because of access to Ryan White Services. Male gender and earlier HIV stage were factors with greatest association with late LTC and NLTC.Disclosures All authors: No reported disclosures.