Division of Disease Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
CUNY Graduate School of Public Health and Health Policy, New York, NY, 10027, USA.
AIDS Behav. 2017 Dec;21(12):3557-3566. doi: 10.1007/s10461-017-1700-2.
We investigated the effect of neighborhood characteristics on achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older diagnosed between 2006 and 2012. Individual records from the NYC HIV surveillance registry (n = 12,547) were linked to U.S. Census and American Community Survey data by census tract of residence. Multivariable proportional hazards regression models indicated the likelihood of achievement and maintenance of suppression by neighborhood characteristics including poverty, accounting for neighborhood clustering and for individual characteristics. In adjusted analyses, no neighborhood factors were associated with achievement of suppression. However, residents of high- or very-high-poverty neighborhoods were less likely than residents of low-poverty neighborhoods to maintain suppression. In conclusion, higher neighborhood poverty was associated with lesser maintenance of suppression. Assistance with post-diagnosis retention in care, antiretroviral therapy prescribing, or adherence targeted to residents of higher-poverty neighborhoods may improve maintenance of viral suppression in NYC.
我们研究了社区特征对纽约市（NYC） 13 岁及以上年龄、2006 至 2012 年间确诊的 HIV 感染者实现并维持病毒抑制的效果。将来自 NYC HIV 监测登记处的个人记录（n=12547），按照居住地的普查区与美国人口普查和美国社区调查数据相联系。多变量比例风险回归模型表明，按照社区特征（包括贫困）来预测抑制效果的实现和维持，其中考虑了社区聚集效应和个体特征。在调整后的分析中，没有社区因素与抑制效果的实现相关。然而，高贫困或极高贫困社区的居民比低贫困社区的居民更不容易维持抑制效果。总之，较高的社区贫困与维持抑制效果较差相关。针对高贫困社区居民的诊断后保持治疗、抗逆转录病毒治疗方案开具或治疗依从性方面的援助，可能会提高 NYC 病毒抑制的维持效果。
