Geoinformation and Big Data Research Lab, Department of Geography, University of South Carolina, Columbia, SC, 29208, USA.
Big Data Health Science Center, University of South Carolina, Columbia, SC, 29208, USA.
AIDS Behav. 2024 Oct;28(Suppl 1):47-60. doi: 10.1007/s10461-023-04163-4. Epub 2023 Oct 4.
BACKGROUND: The COVID-19 pandemic has posed unprecedented pressure to health care systems, and interrupted health care delivery and access including HIV care in the United States' Deep South, which endures a double epidemic of HIV and COVID-19. Ryan White programs cover HIV care services for over half of PLWH in the Deep South. Given the important role of Ryan White programs, examining the visitation changes to Ryan White facilities during the pandemic offers insights into the impact of the pandemic on HIV healthcare utilization. OBJECTIVES: Analyze the geographic distribution of HIV facility visitors at the county level before and during the pandemic in the nine US states of Deep South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas) to reveal the geographic and racial disparity in visitation disruption caused by the pandemic. METHODS: We first extracted mobile device-based visitation data for Ryan White HIV facilities in the Deep South during 2019 and 2020. To quantify the disruption in visitations during 2020, we calculated the visitation reduction rate (VRR) for each county, using 2019 data as the baseline. Next, we conducted a spatial analysis of the VRR values to uncover geographical disparities in visitation interruptions. To investigate racial disparities, we performed spatial regression analyses with VRR as the dependent variable, and the percentages of Black, Hispanic, and Asian populations as the independent variables. In this analysis, we controlled for potential confounders. RESULTS: Geographic disparities in visitation reduction were observed, with all nine Deep South states experiencing significant drops. Georgia experienced the highest visitation loss (VRR = -0.58), followed by Texas (-0.47), Alabama (0.47), and Tennessee (-0.46), while South Carolina had the smallest reductions (-0.11). All the regression models consistently revealed racial disparities in visitation interruption. That is, counties with a higher proportion of Black population tended to have higher RW facility visitation reductions. CONCLUSIONS: Our analysis revealed distinct geographic disparities in visitation interruptions at Ryan White HIV facilities in the Deep South during the COVID-19 pandemic in 2020. Furthermore, we found that the Black/African American population experienced a greater disruption at the county level in the Deep South during this period.
背景：COVID-19 大流行给医疗保健系统带来了前所未有的压力，包括在美国南部地区中断了医疗保健服务和机会，该地区同时面临 HIV 和 COVID-19 的双重流行。Ryan White 计划覆盖了南部地区一半以上的 PLWH 的 HIV 护理服务。鉴于 Ryan White 计划的重要作用，检查大流行期间 Ryan White 设施的访问变化，为了解大流行对 HIV 医疗保健利用的影响提供了线索。
目的：分析美国南部九个州（阿拉巴马州、佛罗里达州、佐治亚州、路易斯安那州、密西西比州、北卡罗来纳州、南卡罗来纳州、田纳西州、得克萨斯州）在大流行前后县一级 HIV 设施访客的地理分布，以揭示大流行造成的访问中断的地理和种族差异。
方法：我们首先提取了南部地区 Ryan White HIV 设施的基于移动设备的访问数据，时间跨度为 2019 年和 2020 年。为了量化 2020 年访问量的减少，我们使用 2019 年的数据作为基线，计算了每个县的访问减少率（VRR）。接下来，我们对 VRR 值进行了空间分析，以揭示访问中断的地理差异。为了研究种族差异，我们以 VRR 为因变量，以黑人群体、西班牙裔群体和亚洲人群体的百分比为自变量，进行了空间回归分析。在这项分析中，我们控制了潜在的混杂因素。
结果：观察到访问减少存在地理差异，南部九个州都经历了显著的下降。佐治亚州的访问量损失最大（VRR=-0.58），其次是得克萨斯州（VRR=-0.47）、阿拉巴马州（VRR=0.47）和田纳西州（VRR=-0.46），而南卡罗来纳州的降幅最小（VRR=-0.11）。所有回归模型都一致显示了访问中断的种族差异。也就是说，黑人人口比例较高的县，Ryan White 设施的访问量减少幅度更大。
结论：我们的分析揭示了南部地区 Ryan White HIV 设施在 2020 年 COVID-19 大流行期间访问中断的明显地理差异。此外，我们发现，在此期间，南部地区的黑人/非裔美国人在县一级的干扰更大。
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