scholarly journals Social Determinants of Health and Disparities in Linkage to Care Among Newly Diagnosed HIV Cases – South Carolina, 2009–2011

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S419-S420 ◽  
Author(s):  
Harmeet Gill ◽  
Oluwole Babatunde ◽  
Sharon Weissman
Keyword(s):  
South Carolina ◽  
Racial Disparities ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Census Tract ◽  
Linkage To Care ◽  
Male Gender ◽  
Determinants Of Health ◽  
Newly Diagnosed ◽  
Hiv Diagnosis

Abstract Background Key to improved HIV outcomes is early diagnosis, linkage to care (LTC), retention in care (RIC) and viral load (VL) suppression. As treatment for HIV has become more effective, the gap in racial disparities has widened for LTC, RIC and VL. Social determinants of health (SDH) are conditions such as poverty level, income, education, employment that are responsible for most health inequities. SDH are drivers of disparities in HIV prevalence. The objective of this study is to evaluate the impact of SDH on racial disparities on time to LTC for newly diagnosed HIV infected individuals in South Carolina (SC). Methods Data was obtained from the SC enhanced HIV/AIDS Reporting System. Analysis includes individuals diagnosed with HIV in SC from 2009–2011. LTC was calculated as the time from HIV diagnosis to first CD4 or VL test. Early LTC was defined as within 30 days. Late LTC was >30 to 365 days. Individuals not LTC by 365 days were considered to have never been linked to care (NLTC). Census tract data was used to determine SHD (poverty, education, income, and unemployment) based on residence at the time of HIV diagnosis. Descriptive analysis was performed on data from newly infected individuals. Factors potentially associated with late LTC and NLTC including patient demographics, behavioral risk, residence at diagnosis and SDH were investigated. Results From 2009–2011, 2151 individuals were newly diagnosed with HIV. Of these 1636 (76.1%) were LTC early, 285 (13.2%) were LTC late and 230 (10.7%) were NLTC. NLTC was associated with male gender, lower initial CD4 count, and earlier stage of HIV at time of diagnoses (P <0.01). In multivariable analysis early HIV stage at HIV diagnosis (aOR: 1.82; 95% CI 1.3, 2.5) and living in census tracts with lower income (aOR 0.65; 95% CI 0.44, 0.97) are associated with late LTC. Male gender (aOR 2.66; 95% CI 1.49, 4.76) unknown HIV risk group (aOR 2.03; 95% CI 1.11, 2.74) and early HIV stage at diagnosis (aOR 4.59; 95% CI 2.33, 9.04) are associated with NLTC. Conclusion In SC, almost ¼ of newly diagnosed HIV infected individuals from 2009–2011 were LTC late or NLTC. SDH were not associated with late LTC or NLTC. Living in a low income census tract was associated with a lower risk for late LTC, possible because of access to Ryan White Services. Male gender and earlier HIV stage were factors with greatest association with late LTC and NLTC. Disclosures All authors: No reported disclosures.

scholarly journals California Healthy Places Index: Frames Matter

2019 ◽  
Vol 134 (4) ◽  
pp. 354-362
Author(s):  
Neil Maizlish ◽  
Tracy Delaney ◽  
Helen Dowling ◽  
Derek A. Chapman ◽  
Roy Sabo ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Census Tract ◽  
Well Being ◽  
Determinants Of Health ◽  
Policy Action ◽  
Census Tracts ◽  
Life Expectancy At Birth ◽  
The Social

Introduction: We describe the California Healthy Places Index (HPI) and its performance relative to other indexes for measuring community well-being at the census-tract level. The HPI arose from a need identified by health departments and community organizations for an index rooted in the social determinants of health for place-based policy making and program targeting. The index was geographically granular, validated against life expectancy at birth, and linked to policy actions. Materials and Methods: Guided by literature, public health experts, and a positive asset frame, we developed a composite index of community well-being for California from publicly available census-tract data on place-based factors linked to health. The 25 HPI indicators spanned 8 domains; weights were derived from their empirical association with tract-level life expectancy using weighted quantile sums methods. Results: The HPI’s domains were aligned with the social determinants of health and policy action areas of economic resources, education, housing, transportation, clean environment, neighborhood conditions, social resources, and health care access. The overall HPI score was the sum of weighted domain scores, of which economy and education were highly influential (50% of total weights). The HPI was strongly associated with life expectancy at birth ( r = 0.58). Compared with the HPI, a pollution-oriented index did not capture one-third of the most disadvantaged quartile of census tracts (representing 3 million Californians). Overlap of the HPI’s most disadvantaged quartile of census tracts was greater for indexes of economic deprivation. We visualized the HPI percentile ranking as a web-based mapping tool that presented the HPI at multiple geographies and that linked indicators to an action-oriented policy guide. Practice Implications: The framing of indexes and specifications such as domain weighting have substantial consequences for prioritizing disadvantaged populations. The HPI provides a model for tools and new methods that help prioritize investments and identify multisectoral opportunities for policy action.

scholarly journals A County-Level Examination of the Relationship Between HIV and Social Determinants of Health: 40 States, 2006-2008

2012 ◽  
Vol 6 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Gant Z ◽  
Lomotey M ◽  
Hall H.I ◽  
Hu X ◽  
Guo X ◽  
...  
Keyword(s):  
Income Inequality ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
The United States ◽  
Determinants Of Health ◽  
Physical Factors ◽  
County Level ◽  
Hiv Diagnosis ◽  
Hiv Surveillance ◽  
The Relationship

Background: Social determinants of health (SDH) are the social and physical factors that can influence unhealthy or risky behavior. Social determinants of health can affect the chances of acquiring an infectious disease – such as HIV – through behavioral influences and limited preventative and healthcare access. We analyzed the relationship between social determinants of health and HIV diagnosis rates to better understand the disparity in rates between different populations in the United States. Methods: Using National HIV Surveillance data and American Community Survey data at the county level, we examined the relationships between social determinants of health variables (e.g., proportion of whites, income inequality) and HIV diagnosis rates (averaged for 2006-2008) among adults and adolescents from 40 states with mature name-based HIV surveillance. Results: Analysis of data from 1,560 counties showed a significant, positive correlation between HIV diagnosis rates and income inequality (Pearson correlation coefficient ρ = 0.40) and proportion unmarried – ages >15 (ρ = 0.52). There was a significant, negative correlation between proportion of whites and rates (ρ = -0.67). Correlations were low between racespecific social determinants of health indicators and rates. Conclusions/Implications: Overall, HIV diagnosis rates increased as income inequality and the proportion unmarried increased, and rates decreased as proportion of whites increased. The data reflect the higher HIV prevalence among non-whites. Although statistical correlations were moderate, identifying and understanding these social determinants of health variables can help target prevention efforts to aid in reducing HIV diagnosis rates. Future analyses need to determine whether the higher proportion of singles reflects higher populations of gay and bisexual men.

Geographic Differences and Social Determinants of Health Among People With HIV Attributed to Injection Drug Use, United States, 2017

2021 ◽  
pp. 003335492110071
Author(s):  
Chan Jin ◽  
Ndidi Nwangwu-Ike ◽  
Zanetta Gant ◽  
Shacara Johnson Lyons ◽  
Anna Satcher Johnson
Keyword(s):  
United States ◽  
Health Insurance ◽  
Drug Use ◽  
Hiv Infection ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Census Tract ◽  
People Who Inject Drugs ◽  
Hiv Diagnosis ◽  
Census Tract Level

Objective People who inject drugs are among the groups most vulnerable to HIV infection. The objective of this study was to describe differences in the geographic distribution of HIV diagnoses and social determinants of health (SDH) among people who inject drugs (PWID) who received an HIV diagnosis in 2017. Methods We used data from the National HIV Surveillance System (NHSS) to determine the counts and percentages of PWID aged ≥18 with HIV diagnosed in 2017. We combined these data with data from the US Census Bureau’s American Community Survey at the census tract level to examine regional, racial/ethnic, and population-area-of-residence differences in poverty status, education level, income level, employment status, and health insurance coverage. Results We observed patterns of disparity in HIV diagnosis counts and SDH among the 2666 PWID with a residential address linked to a census tract, such that counts of HIV diagnosis increased as SDH outcomes became worse. The greatest proportion of PWID lived in census tracts where ≥19% of the residents lived below the federal poverty level, ≥18% of the residents had <high school diploma, the median annual household income was <$40 000, and ≥16% of the residents did not have health insurance or a health coverage plan. Conclusion To our knowledge, our study is the first large-scale, census tract–level study to describe SDH among PWID with diagnosed HIV in the United States. The findings of substantial disparities in SDH among people with HIV infection attributed to injection drug use should be further examined. Understanding the SDH among PWID is crucial to reducing disparities in HIV diagnoses in this population.

scholarly journals 1070. Risk factors for failed linkage to Hepatitis C care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S563-S563
Author(s):  
Carlo Fopiano Palacios ◽  
Lauren Hynicka ◽  
Sarah Schmalzle
Keyword(s):  
Risk Factors ◽  
Hepatitis C ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Linkage To Care ◽  
Retrospective Chart Review ◽  
Clinic Visit ◽  
Determinants Of Health ◽  
Chi Square ◽  
Clinic Appointment

Abstract Background Many patients with Hepatitis C (HCV) who are referred to HCV care do not attend their HCV clinic appointments. As social determinants of health are known to affect HCV acquisition, we sought to evaluate their role on successful linkage to HCV care also. Methods A retrospective chart review was conducted on patients with both a positive HCV antibody or RNA test and a scheduled but not-attended infectious disease (ID) clinic appointment in 2017. Abstracted data included patient demographic, type of insurance, HCV test results, and risk factors that may impair outpatient HCV linkage. Descriptive statistics, chi-square, and Fisher exact tests were performed. We sought to identify the factors limiting patients with HCV from attending their first clinic visit. Results There were 161 out of 1539 patients (10%) who did not keep their HCV clinic appointment. The mean age was 48 years, 45% were female, and the majority were African American (61%). Most patients had insurance that was accepted by the HCV clinic (76%) and had been tested for HCV while admitted to the hospital (94%). Almost all patients had been tested both for HCV antibodies (98%) and viral RNA via PCR (97%). Risk factors known to contribute to unsuccessful linkage to care were common: substance use (85%), mental health diagnosis (71%), inadequate transportation (66%), housing insecurity (61%), history of medication nonadherence (61%), and alcohol use (52%). Seven patients (4%) died by the end of 2017. Patients alive at the end of 2017 were more likely to have insurance accepted at the ID clinic compared to those without accepting insurance (98% vs. 90%, p 0.06). Conclusion Significant barriers are present among patients with HCV who were not successfully linked to a scheduled HCV appointment. Patients with HCV should be provided additional support as appropriate to address the social determinants of health that may limit their linkage to HCV care. Lack of accepted insurance at the ID clinic was associated with mortality and warrants further investigation into its causes. Disclosures All Authors: No reported disclosures

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