South Carolina SmartState Center for Healthcare Quality.
Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina.
AIDS. 2021 May 1;35(Suppl 1):S53-S64. doi: 10.1097/QAD.0000000000002832.
The aim of this study was to examine the geospatial variation of retention in care (RIC) across the counties in South Carolina (SC) from 2010 to 2016 and identify the relevant county-level predictors.
Aggregated data on county-level RIC among HIV patients from 2010 to 2016 were retrieved from an electronic HIV/AIDS reporting system in SC Department of Health and Environmental Control. Sociological framework of health was used to select potential county-level predictors from multiple public datasets.
Geospatial mapping was used to display the spatial heterogeneity of county-level RIC rate in SC. Generalized linear mixed effect regression with least absolute shrinkage and selection operator (LASSO) was employed to identify county-level predictors related to the change of RIC status over time. Confusion matrix and area under the curve statistics were used to evaluate model performance.
More than half of the counties had their RIC rates lower than the national average. The change of county-level RIC rate from 2010 to 2016 was not significant, and spatial heterogeneity in RIC rate was identified. A total of 22 of the 31 county-level predictors were selected by LASSO for predicting county-level RIC status. Counties with lower collective efficacy, larger proportions of men and/or persons with high education were more likely to have their RIC rates lower than the national average. In contrast, numbers of accessible mental health centres were positively related to county-level RIC status.
Spatial variation in RIC could be identified, and county-level factors associated with accessible healthcare facilities and social capital significantly contributed to these variations. Structural and individual interventions targeting these factors are needed to improve the county-level RIC and reduce the spatial variation in HIV care.
本研究旨在探讨 2010 年至 2016 年南卡罗来纳州（SC）各县保留治疗（RIC）的地理空间变化，并确定相关的县级预测因素。
从 SC 卫生部和环境控制电子艾滋病毒/艾滋病报告系统中检索了 2010 年至 2016 年 HIV 患者的县级 RIC 汇总数据。使用健康社会学框架从多个公共数据集选择潜在的县级预测因素。
使用地理空间映射显示 SC 县级 RIC 率的空间异质性。使用广义线性混合效应回归和最小绝对收缩和选择算子（LASSO）来确定与 RIC 状态随时间变化相关的县级预测因素。使用混淆矩阵和曲线下面积统计数据评估模型性能。
超过一半的县的 RIC 率低于全国平均水平。2010 年至 2016 年县级 RIC 率的变化不显著，并且确定了 RIC 率的空间异质性。LASSO 共选择了 31 个县级预测因素中的 22 个来预测县级 RIC 状态。集体效能较低、男性比例较高和/或高学历者比例较高的县，其 RIC 率低于全国平均水平的可能性更大。相反，可获得的心理健康中心数量与县级 RIC 状况呈正相关。
可以确定 RIC 的空间变化，与可获得医疗保健设施和社会资本相关的县级因素对这些变化有显著影响。需要针对这些因素进行结构性和个体干预，以提高县级 RIC 并减少艾滋病毒护理的空间差异。
