Abstract
BackgroundThere were 28,055 people living with HIV (PLWH) in Miami-Dade County (MDC) in 2017; 40.1% was either out of care or was not virally suppressed (uncontrolled HIV). The purpose of this study was to determine the association between the social determinants of health (SDOH) and the number of persons with uncontrolled HIV in MDC.SettingThis cross-sectional study included PLWH 15 and older with uncontrolled HIV in MDC, 2017. Data on PLWH’s viral load, age, gender, mode of HIV transmission, and race/ethnicity were aggregated to the ZIP code level. All five SDOH per HealthyPeople 2020 were represented: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment.MethodsDescriptive analyses on all study variables and a principal component analysis on the SDOH variables were performed. To account for overdispersion, multivariate negative binomial regressions were run while controlling for confounders and testing for significant interactions.ResultsThe results of the regression analysis indicated that an increase in Factor 1 (economic stability, education, and health and healthcare determinants) was associated with a statistically significant increase in the number of PLWH with uncontrolled HIV. Additionally, we found a significant interaction between Factor 1 and White race. Among persons of low socioeconomic status, White race is associated with a reduction in PLWH with uncontrolled HIV.ConclusionsThese results suggest that reducing poverty and increasing education and rates of health insurance should result in significant reductions in PLWH with uncontrolled HIV. These results have the potential to influence future policy, interventions for retention, adherence, and continuity of care to improve suppression rates in MDC.
Highlights
There are over one million people living with HIV (PLWH) in the USA, and in 2017, there were over 38,000 new HIVMiami, Miami, FL, USA 4 AIDS Healthcare Foundation (AHF) Global Public Health Institute, University of Miami, Miami, FL 33136, USA 5 Department of Public Health Sciences, University of Miami, Miami, FL, USA diagnoses in the country, 52% of which were diagnosed in the South [1]
Factor 1 values ranged from − 2.29 to 1.94, with the higher positive numbers representing the lowest socioeconomic status (SES), lowest education, and least access to health insurance
Factor 3 values ranged from − 2.41 to 2.12, with the higher positive numbers indicating the lowest proportion of people with access to foods
Summary
There are over one million people living with HIV (PLWH) in the USA, and in 2017, there were over 38,000 new HIV. There were 28,055 people living with HIV (PLWH) in Miami-Dade County (MDC) in 2017; 40.1% was either out of care or was not virally suppressed (uncontrolled HIV). The purpose of this study was to determine the association between the social determinants of health (SDOH) and the number of persons with uncontrolled HIV in MDC. Setting This cross-sectional study included PLWH 15 and older with uncontrolled HIV in MDC, 2017. All five SDOH per HealthyPeople 2020 were represented: economic stability, education, social and community context, health and healthcare, and neighborhood and built environment
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