Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, 2525 West End Ave, Suite 750, Nashville, TN, 37203, USA.
Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
J Racial Ethn Health Disparities. 2022 Jun;9(3):849-855. doi: 10.1007/s40615-021-01023-6. Epub 2021 Apr 19.
Guided by an intersectional approach, we assessed the association between social categories (individual and combined) on time to linkage to HIV care in Tennessee.
Tennessee residents diagnosed with HIV from 2012-2016 were included in the analysis (n=3750). Linkage was defined by the first CD4 or HIV RNA test date after HIV diagnosis. We used Cox proportional hazards models to assess the association of time to linkage with individual-level variables. We modeled interactions between race, age, gender, and HIV acquisition risk factor (RF), to understand how these variables jointly influence linkage to care.
Age, race, and gender/RF weAima A. Ahonkhaire strong individual (p < 0.001 for each) and joint predictors of time to linkage to HIV care (p < 0.001 for interaction). Older individuals were more likely to link to care (aHR comparing 40 vs. 30 years, 1.20, 95%CI 1.11-1.29). Blacks were less likely to link to care than Whites (aHR= 0.73, 95% CI: 0.67-0.79). Men who have sex with men (MSM) (aHR = 1.18, 95%CI: 1.03-1.34) and heterosexually active females (females) (aHR = 1.32, 95%CI: 1.14-1.53) were more likely to link to care than heterosexually active males. The three-way interaction between age, race, and gender/RF showed that Black males overall and young, heterosexually active Black males in particular were least likely to establish care.
Racial disparities persist in establishing HIV care in Tennessee, but data highlighting the combined influence of age, race, gender, and sexual orientation suggest that heterosexually active Black males should be an important focus of targeted interventions for linkage to HIV care.
本研究采用交叉学科方法，评估了田纳西州社会类别（个体和组合）与艾滋病毒感染者接受护理的时间之间的关联。
本研究纳入了 2012 年至 2016 年间在田纳西州被诊断为 HIV 的居民（n=3750）。将首次 CD4 或 HIV RNA 检测日期定义为 HIV 诊断后的开始时间。采用 Cox 比例风险模型评估个体变量与开始时间的关联。构建种族、年龄、性别和 HIV 感染风险因素（RF）之间的交互作用模型，以了解这些变量如何共同影响接受 HIV 护理的联系。
年龄、种族和性别/RF 是个体（p < 0.001）和联合预测 HIV 护理开始时间的重要因素（p < 0.001）。年龄较大的个体更有可能开始接受护理（比较 40 岁和 30 岁的个体，aHR 为 1.20，95%CI 为 1.11-1.29）。与白人相比，黑人更不可能开始接受护理（aHR=0.73，95%CI：0.67-0.79）。男男性行为者（MSM）（aHR = 1.18，95%CI：1.03-1.34）和异性活跃女性（女性）（aHR = 1.32，95%CI：1.14-1.53）更有可能开始接受护理。年龄、种族和性别/RF 之间的三向交互作用表明，黑人男性和年轻的异性活跃的黑人男性总体上最不可能开始接受护理。
在田纳西州，HIV 护理的建立仍然存在种族差异，但数据突出了年龄、种族、性别和性取向的综合影响，表明异性活跃的黑人男性应成为 HIV 护理联系的目标干预的重要重点。
