Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, USA.
Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
J Urban Health. 2024 Feb;101(1):31-63. doi: 10.1007/s11524-023-00801-3. Epub 2023 Dec 13.
Social determinants have been increasingly implicated in accelerating HIV vulnerability, particularly for disenfranchised communities. Among these determinants, neighborhood factors play an important role in undermining HIV prevention. However, there has been little research comprehensively examining the impact of neighborhood factors on HIV care continuum participation in the US. To address this, we conducted a systematic review (PROSPERO registration number CRD42022359787) to determine neighborhood factors most frequently associated with diminished HIV care continuum participation. Peer-reviewed studies were included if published between 2013 - 2022, centralized in the US, and analyzed a neighborhood factor with at least one aspect of the HIV care continuum. The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Study quality was guided by LEGEND (Let Evidence Guide Every New Decision) evaluation guidelines. Systematic review analysis was conducted using Covidence software. There were 3,192 studies identified for initial screening. Forty-four were included for review after eliminating duplicates, title/abstract screening, and eligibility assessment. Social and economic disenfranchisement of neighborhoods negatively impacts HIV care continuum participation among persons living with HIV. In particular, five key neighborhood factors (socioeconomic status, segregation, social disorder, stigma, and care access) were associated with challenged HIV care continuum participation. Race moderated relationships between neighborhood quality and HIV care continuum participation. Structural interventions addressing neighborhood social and economic challenges may have favorable downstream effects for improving HIV care continuum participation.
社会决定因素在加速 HIV 易感性方面的作用越来越大,尤其是对弱势群体社区而言。在这些决定因素中,邻里因素在破坏 HIV 预防方面起着重要作用。然而,几乎没有研究全面检查邻里因素对美国 HIV 护理连续体参与的影响。为了解决这个问题,我们进行了一项系统评价(PROSPERO 注册号 CRD42022359787),以确定与 HIV 护理连续体参与度降低最相关的邻里因素。如果研究发表于 2013 年至 2022 年之间,集中在美国,并且分析了与 HIV 护理连续体至少一个方面相关的邻里因素,则可以纳入同行评审研究。该综述遵循系统评价和荟萃分析的首选报告项目(PRISMA)协议。研究质量由 LEGEND(让证据指导每个新决策)评估指南指导。使用 Covidence 软件进行系统评价分析。最初筛选出 3192 项研究。在消除重复项、标题/摘要筛选和资格评估后,有 44 项研究被纳入审查。邻里的社会和经济剥夺会对 HIV 感染者参与 HIV 护理连续体产生负面影响。特别是,五个关键的邻里因素(社会经济地位、隔离、社会混乱、污名和护理可及性)与挑战 HIV 护理连续体参与度有关。种族调节了邻里质量与 HIV 护理连续体参与度之间的关系。解决邻里社会和经济挑战的结构性干预措施可能会对改善 HIV 护理连续体参与度产生有利的下游影响。
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