Kimaru Linda Jepkoech, Hu ChengCheng, Nagalingam Sudha, Magrath Priscilla, Connick Elizabeth, Ernst Kacey, Ehiri John
Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America.
Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America.
PLOS Glob Public Health. 2024 Dec 19;4(12):e0004060. doi: 10.1371/journal.pgph.0004060. eCollection 2024.
Adherence to antiretroviral therapy (ART) is crucial for achieving and maintaining viral suppression in people living with HIV (PLWH). While individual factors affecting HIV viral suppression have been extensively studied, there is less attention on community-level factors, specifically perceived neighborhood disorder. This study aims to assess the relationship between perceived neighborhood disorder and achieving virologic suppression among people living with HIV. One hundred and eighty-eight PLWH 18 years of age and older from two HIV clinics completed a cross-sectional study. We assessed perceptions of neighborhood disorder, ART self-efficacy, social support, alcohol and drug use, depression, HIV stigma, provider-patient relationship, demographics, and length at the zip code. HIV viral loads were obtained from the clinical record. The analysis involved the use of Fisher's Exact test, Spearman's Rank test, Wilcoxon rank sum test, and Firth logistic regression. All analyses were conducted using STATA 17. Most participants were male (79%), white (62%), and identified as non-Hispanic (66%). Individuals with no perceived neighborhood disorder had median scores of 10 for integration and perseverance in ART self-efficacy. Those with high perceived disorder displayed decreased scores of 8.4 and 8.3 for integration and perseverance respectively. Both integration and perseverance showed statistically significant negative correlations with perceived neighborhood disorder, (Spearman's rho -0.2966; p<0.000 and -0.2387; p = 0.0010 respectively). Individuals with virologic suppression (n = 167) reported significantly lower perceived neighborhood disorder scores (median = 0.9 [IQR: 0.2-2.0]) compared to those without virologic suppression (n = 10, median = 3.2 [IQR: 2.4-4], p = 0.0012). The study highlights a notable correlation between perceived neighborhood disorder, ART adherence self-efficacy, and virologic suppression. This indicates that improving HIV treatment outcomes needs to extend beyond individual-level factors and include strategies to address neighborhood-level conditions. Public health policies and programs should consider the broader social and environmental contexts in which people living with HIV reside.
坚持抗逆转录病毒疗法（ART）对于实现并维持艾滋病毒感染者（PLWH）的病毒抑制至关重要。虽然影响艾滋病毒病毒抑制的个体因素已得到广泛研究，但对社区层面的因素，特别是感知到的邻里失序关注较少。本研究旨在评估感知到的邻里失序与艾滋病毒感染者实现病毒学抑制之间的关系。来自两家艾滋病毒诊所的188名18岁及以上的艾滋病毒感染者完成了一项横断面研究。我们评估了对邻里失序的感知、抗逆转录病毒疗法自我效能感、社会支持、酒精和药物使用、抑郁、艾滋病毒污名、医患关系、人口统计学特征以及邮政编码区域的居住时长。艾滋病毒载量从临床记录中获取。分析采用了Fisher精确检验、Spearman秩检验、Wilcoxon秩和检验以及Firth逻辑回归。所有分析均使用STATA 17进行。大多数参与者为男性（79%）、白人（62%），且被认定为非西班牙裔（66%）。未感知到邻里失序的个体在抗逆转录病毒疗法自我效能感的整合和毅力方面的中位数得分是10分。感知到高度失序的个体在整合和毅力方面的得分分别降至8.4分和8.3分。整合和毅力与感知到的邻里失序均呈现出具有统计学意义的负相关（Spearman相关系数分别为-0.2966；p<0.000和-0.2387；p = 0.0010）。与未实现病毒学抑制的个体（n = 10，中位数 = 3.2 [四分位间距：2.4 - 4]）相比，实现病毒学抑制的个体（n = 167）报告的感知邻里失序得分显著更低（中位数 = 0.9 [四分位间距：0.2 - 2.0]，p = 0.0012）。该研究突出了感知到的邻里失序、抗逆转录病毒疗法依从性自我效能感与病毒学抑制之间的显著相关性。这表明改善艾滋病毒治疗结果需要超越个体层面的因素，还应包括解决邻里层面状况的策略。公共卫生政策和项目应考虑艾滋病毒感染者所处的更广泛的社会和环境背景。
