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- Title
Trends and Disparities in Mortality and Progression to AIDS in the Highly Active Antiretroviral Therapy Era: Tennessee, 1996–2016.
- Authors
Rebeiro, Peter F.; Pettit, April C.; Sizemore, Lindsey; Mathieson, Samantha A.; Wester, Carolyn; Kipp, Aaron; Shepherd, Bryan E.; Sterling, Timothy R.
- Abstract
Objectives. To use statewide surveillance data to examine trends and disparities in mortality and progression from HIV to AIDS comprehensively in Tennessee over the past 20 years. Methods. Individuals diagnosed with HIV in Tennessee from 1996 to 2016 were identified through the Tennessee Department of Health Enhanced HIV/AIDS Reporting System. Clinical AIDS and all-cause mortality were the outcomes. Cox regression yielded adjusted hazard ratios (AHRs) for death and competing risk regression yielded adjusted subhazard ratios (SHRs) for AIDS, with death as the competing event. Results. Individuals with a history of heterosexual contact (AHR = 1.20; 95% confidence interval [CI] = 1.12, 1.29) and injection drug use (AHR = 1.27; 95% CI = 1.18, 1.38) had increased hazards of death relative to those with a history of male-to-male sexual contact. Hazards of death were lower among White (AHR = 0.79; 95% CI = 0.73, 0.85) and Hispanic (AHR = 0.50; 95% CI = 0.40, 0.63) individuals than among Black individuals. Those with heterosexual contact (SHR = 1.20; 95% CI = 1.12, 1.29) and injection drug use (SHR = 1.27; 95% CI = 1.18, 1.38) had a greater risk of AIDS than those with male-to-male sexual contact. White individuals (SHR = 0.85; 95% CI = 0.81, 0.90) had a lower risk of AIDS than Black individuals, and female individuals (SHR = 0.84; 95% CI = 0.79, 0.90) had a lower risk than male individuals. Conclusions. The trends, disparities, and outcomes assessed in our study will inform HIV testing and care linkage program design and implementation in Tennessee.
- Subjects
UNITED States; TENNESSEE; MORTALITY; HIV-positive persons; MORTALITY of AIDS patients; HIGHLY active antiretroviral therapy; HEALTH equity; DIAGNOSIS of HIV infections; DEATH rate; AIDS; AIDS risk factors; MORTALITY risk factors; BLACK people; CONFIDENCE intervals; HETEROSEXUALITY; HISPANIC Americans; HIV infections; PUBLIC health surveillance; REGRESSION analysis; SEX distribution; SUBSTANCE abuse; WHITE people; TREATMENT effectiveness; HUMAN services programs; PROPORTIONAL hazards models; DISEASE progression; ODDS ratio
- Publication
American Journal of Public Health, 2019, Vol 109, Issue 9, p1266
- ISSN
0090-0036
- Publication type
Article
- DOI
10.2105/AJPH.2019.305180