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艾滋病护理留存率与病毒抑制:种族/民族差异的个体及社区层面预测因素,佛罗里达州,2015年

Retention in HIV Care and Viral Suppression: Individual- and Neighborhood-Level Predictors of Racial/Ethnic Differences, Florida, 2015.

作者信息

Sheehan Diana M, Fennie Kristopher P, Mauck Daniel E, Maddox Lorene M, Lieb Spencer, Trepka Mary Jo

机构信息

1 Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University , Miami, Florida.

2 HIV/AIDS Section, Florida Department of Health , Tallahassee, Florida.

出版信息

AIDS Patient Care STDS. 2017 Apr;31(4):167-175. doi: 10.1089/apc.2016.0197.

Abstract

The objective of this study was to estimate racial/ethnic differences in retention in HIV care and viral suppression and to identify related individual and neighborhood determinants. Florida HIV surveillance records of cases aged ≥13 years diagnosed during the years 2000-2014 were analyzed. Retention in care was defined as evidence of ≥2 or more laboratory tests, receipts of prescription, or clinical visits at least 3 months apart during 2015. Viral load suppression was defined as a viral load of <200 copies/mL for the last test in 2015. Multi-level logistic regressions were used to estimate adjusted odds ratios (AORs). Of 65,735 cases, 33.3% were not retained in care, and 40.1% were not virally suppressed. After controlling for individual and neighborhood factors, blacks were at increased odds of nonretention in HIV care [AOR 1.29, 95% confidence interval (CI) 1.23-1.35] and nonviral suppression (AOR 1.55, 95% CI 1.48-1.63) compared with whites. Black and Latino males compared with their female counterparts had higher odds of nonretention and nonviral suppression. Compared with their US-born counterparts, foreign-born blacks and whites, but not Latinos, had higher odds of nonretention and nonviral suppression. Blacks and whites in urban compared with rural areas had higher odds of both outcomes. Disparities in retention in care and viral suppression persist and are not accounted for by differences in age, sex, transmission mode, AIDS diagnosis, neighborhood socioeconomic status, rural/urban residence, or neighborhood racial composition. Further, predictors of poor retention in care and viral suppression appear to differ by race/ethnicity.

摘要

本研究的目的是评估接受HIV治疗的留存率及病毒抑制方面的种族/族裔差异,并确定相关的个体和社区决定因素。分析了2000 - 2014年期间诊断出的年龄≥13岁的佛罗里达州HIV监测病例记录。治疗留存率定义为2015年期间至少有2次或更多实验室检查、处方领取记录或临床就诊记录,且就诊间隔至少3个月。病毒载量抑制定义为2015年最后一次检测的病毒载量<200拷贝/毫升。采用多水平逻辑回归来估计调整后的优势比(AOR)。在65735例病例中,33.3%未坚持接受治疗,40.1%病毒未得到抑制。在控制个体和社区因素后,与白人相比,黑人未坚持接受HIV治疗(AOR 1.29,95%置信区间[CI] 1.23 - 1.35)和病毒未得到抑制(AOR 1.55,95% CI 1.48 - 1.63)的几率更高。与女性相比,黑人男性和拉丁裔男性未坚持治疗和病毒未得到抑制的几率更高。与在美国出生的同龄人相比,外国出生的黑人和白人(但拉丁裔不是)未坚持治疗和病毒未得到抑制的几率更高。与农村地区相比,城市中的黑人和白人出现这两种结果的几率更高。治疗留存率和病毒抑制方面存在的差异依然存在,且不受年龄、性别、传播方式、艾滋病诊断、社区社会经济地位、农村/城市居住情况或社区种族构成差异的影响。此外,治疗留存率低和病毒抑制效果差的预测因素似乎因种族/族裔而异。

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