Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA.
Center for Substance Use and HIV/AIDS Research on Latinos in the United States (C-SALUD), Florida International University, Miami, FL, USA.
BMC Public Health. 2020 Mar 13;20(1):326. doi: 10.1186/s12889-020-8442-1.
HIV viral suppression is associated with health benefits for people living with HIV and a decreased risk of HIV transmission to others. The objective was to identify demographic, psychosocial, provider and neighborhood factors associated with sustained viral suppression among gay, bisexual, and other men who have sex with men.
Data from adult men who have sex with men (MSM) enrolled in the Miami-Dade County Ryan White Program (RWP) before 2017 were used. Sustained viral suppression was defined as having an HIV viral load < 200 copies/ml in all viral load tests in 2017. Three-level (individual, medical case management site, and neighborhood) cross-classified mixed-effect models were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for sustained viral suppression.
Of 3386 MSM, 90.8% were racial/ethnic minorities, and 84.4% achieved sustained viral suppression. The odds of achieving sustained viral suppression was lower for 18-24 and 25-34 year-old MSM compared with 35-49 year-old MSM, and for non-Latino Black MSM compared with White MSM. Those not enrolled in the Affordable Care Act, and those with current AIDS symptoms and a history of AIDS had lower odds of achieving sustained viral suppression. Psychosocial factors significantly associated with lower odds of sustained viral suppression included drug/alcohol use, mental health symptoms, homelessness, and transportation to appointment needs. Individuals with an HIV physician who serves a larger volume of RWP clients had greater odds of sustained viral suppression. Neighborhood factors were not associated with sustained viral suppression.
Despite access to treatment, age and racial disparities in sustained viral suppression exist among MSM living with HIV. Addressing substance use, mental health, and social services' needs may improve the ability of MSM to sustain viral suppression long-term. Furthermore, physician characteristics may be associated with HIV outcomes and should be explored further.
HIV 病毒抑制与 HIV 感染者的健康益处相关，也可降低 HIV 向他人传播的风险。本研究旨在确定与男同性恋者、双性恋者和其他男男性行为者（MSM）持续病毒抑制相关的人口统计学、心理社会、提供者和社区因素。
本研究使用了 2017 年之前参加迈阿密戴德县 Ryan White 计划（RWP）的成年 MSM 的数据。持续病毒抑制定义为在 2017 年所有 HIV 病毒载量检测中 HIV 病毒载量<200 拷贝/ml。使用三级（个体、医疗病例管理站点和社区）交叉分类混合效应模型来估计持续病毒抑制的调整比值比（aOR）和 95%置信区间（CI）。
在 3386 名 MSM 中，90.8%为少数民族，84.4%实现了持续病毒抑制。与 35-49 岁 MSM 相比，18-24 岁和 25-34 岁 MSM 实现持续病毒抑制的可能性较低，与非拉丁裔黑人 MSM 相比，白人 MSM 实现持续病毒抑制的可能性较低。未参加《平价医疗法案》、当前有艾滋病症状和艾滋病病史的 MSM 实现持续病毒抑制的可能性较低。与较低的持续病毒抑制可能性显著相关的心理社会因素包括药物/酒精使用、心理健康症状、无家可归和就诊交通需求。与为更多 RWP 客户提供服务的 HIV 医生合作的患者，实现持续病毒抑制的可能性更大。社区因素与持续病毒抑制无关。
尽管能够获得治疗，但 HIV 感染者中 MSM 持续病毒抑制存在年龄和种族差异。解决药物使用、心理健康和社会服务需求，可能会提高 MSM 长期维持病毒抑制的能力。此外，医生特征可能与 HIV 结局相关，应进一步探讨。
