Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, #W6501, Baltimore, MD, 21205, USA.
Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
AIDS Behav. 2020 Oct;24(10):2811-2818. doi: 10.1007/s10461-020-02830-4.
Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes.
确定影响 HIV 结果的结构决定因素对于在不同地理位置的干预措施具有重要意义。纵向层次广义混合效应模型用于量化特定结构水平因素的变化与 HIV 护理参与、药物依从性和病毒抑制之间的关联。在 WIHS 中，HIV 感染者中，每增加 10 个单位的普查地段失业率、贫困率和无车拥有率，与病毒抑制和药物依从性呈负相关，而教育程度和自有住房与这两个结果呈正相关。值得注意的是，居住稳定性的增加（aOR 5.68，95%CI 2.93，9.04）与 HIV 护理参与呈正相关，失业（aOR：1.59，95%CI 1.57，1.60）、无车拥有（aOR 1.14，95%CI 1.13，1.15）和女性为户主的家庭（aOR 1.23，95%CI 1.22，1.23）也是如此。这强调了理解邻里环境的重要性，包括那些可能不总是被认为有影响力的因素，以实现最佳的 HIV 相关结果。
