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Behind the cascade: analyzing spatial patterns along the HIV care continuum.

Michael G Eberhart1, Baligh R Yehia, Amy Hillier

  • 1*AIDS Activities Coordinating Office, Philadelphia Department of Public Health, Philadelphia, PA; †Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; ‡Philadelphia Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; §University of Pennsylvania School of Design, Philadelphia, PA; ‖Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, and ¶Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and #Treatment Research Institute, Philadelphia, PA.

Journal of Acquired Immune Deficiency Syndromes (1999)
|October 16, 2013
PubMed
Summary

Spatial analysis identified geographic "hot spots" for HIV care gaps. Residing in these areas significantly increased the risk of not linking to care, not being retained, and not achieving viral suppression.

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Area of Science:

  • Public Health
  • Epidemiology
  • Geographic Information Systems (GIS)

Background:

  • HIV treatment as prevention necessitates testing, awareness, linkage, retention in care, and viral suppression.
  • Spatial analysis can identify geographic areas with suboptimal HIV care outcomes.

Purpose of the Study:

  • To investigate the utility of spatial analysis in identifying geographic disparities in the HIV care cascade.
  • To determine if spatial patterns are independent predictors of linkage to care, retention in care, and viral suppression.

Main Methods:

  • Retrospective cohort study of 1704 individuals diagnosed with HIV in Philadelphia (2008-2011).
  • Analysis of outcomes including linkage to care, timely linkage (within 90 days), retention in care, and viral suppression.
  • Application of K-functions to identify spatial "hot spots" and inclusion of geographic data in regression models.

Main Results:

  • 82% linked to care, 75% within 90 days, 37% retained, and 72% achieved viral suppression.
  • Fifty-nine census tracts identified as "hot spots" with no overlap between different outcomes.
  • Individuals in spatial "hot spots" had significantly higher odds of not linking to care (aOR=1.76), not linking within 90 days (aOR=1.49), not being retained (aOR=1.84), and not achieving viral suppression (aOR=3.23).

Conclusions:

  • Spatial patterns are a significant independent predictor of linkage to care, retention in care, and viral suppression in the HIV treatment cascade.
  • Spatial analyses are valuable tools for characterizing the HIV epidemic and targeting interventions to specific geographic areas.