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- Title
Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010–2015.
- Authors
Crockett, Kaylee B; Schember, Cassandra O; Bian, Aihua; Rebeiro, Peter F; Keruly, Jeanne; Mayer, Kenneth; Mathews, Christopher; Moore, Richard D; Crane, Heidi; Geng, Elvin; Napravnik, Sonia; Shepherd, Bryan E; Mugavero, Michael J; Turan, Bulent; Pettit, April C
- Abstract
Background Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. Methods Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. Results Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. Conclusions Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.
- Subjects
UNITED States; HIV infections; RACISM; PSYCHOLOGY of Black people; STRUCTURAL equation modeling; HEALTH services accessibility; SCIENTIFIC observation; SUBSTANCE abuse; CONFIDENCE intervals; MULTIVARIATE analysis; HEALTH outcome assessment; MENTAL health; HEALTH status indicators; MEDICAL care; PEARSON correlation (Statistics); MEDICAL records; DESCRIPTIVE statistics; RESEARCH funding; RESIDENTIAL patterns; SOCIODEMOGRAPHIC factors; STATISTICAL correlation; ODDS ratio; PSYCHOLOGY of HIV-positive persons; LONGITUDINAL method
- Publication
Clinical Infectious Diseases, 2023, Vol 76, Issue 12, p2163
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciad069