Individual- and Neighborhood-Level Predictors of HIV Care Continuum Progression: Clark County, Nevada

As the US human immunodeficiency virus (HIV) epidemic is disproportionately affecting underserved communities, it is critically important to investigate how social determinants of health affect diagnosis, treatment, and prevention of HIV infection and access to care. This article presents an investigation of the HIV epidemic in Clark County, Nevada, to identify local predictors of progression along the HIV care continuum.

Deidentified HIV surveillance data from 2011 to 2022 were analyzed. We investigated associations between stages of care and individual-level demographics and zip code-level characteristics using (1) generalized linear mixed-effects models for univariate analysis, (2) penalized generalized linear mixed-effects models to simultaneously conduct variable selection and estimation for multivariate analysis, and (3) geospatial analysis.

Individual-level factors (diagnosis year, age at diagnosis, being Hispanic, being a man who has sex with men, sex at birth, and individual-level membership in a genetic cluster) and zip code-level factors (genetic clustering and social determinants of health, including level of poverty, proportion Hispanic, proportion with high school education, proportion white, and employment status) were associated with progression through the care continuum. A key result from our multivariate analysis is higher-poverty areas are associated with lower rates of persons with HIV in care (estimate [SE], -0.42 [0.17]; P = .02) and viral suppression (-0.48 [0.15]; P = .001).

Our findings highlight the need for linking and engaging individuals in higher-poverty neighborhoods to medical providers. Furthermore, our results support the need for additional treatment adherence services in those same neighborhoods to increase viral suppression rates.