Longitudinal Associations Between Neighborhood Factors and HIV Care Outcomes in the WIHS

• DOI: 10.1007/s10461-020-02830-4
• Publication Date: 2020-03-13T16:03:52Z
• Authors: Aruna Chandran; Andrew Edmonds; Lorie Benning; Eryka Wentz; Adebola Adedimeji; Tracey E. Wilson; Amanda Blair-Spence; Kartika Palar; Mardge Cohen; Adaora Adimora
• Keywords: Health psychology; Educational Attainment; Census tract; Longitudinal Study

Identifying structural determinants affecting HIV outcomes is important for informing interventions across heterogeneous geographies. Longitudinal hierarchical generalized mixed-effects models were used to quantify the associations between changes in certain structural-level factors on HIV care engagement, medication adherence, and viral suppression. Among women living with HIV in the WIHS, ten-unit increases in census-tract level proportions of unemployment, poverty, and lack of car ownership were inversely associated with viral suppression and medication adherence, while educational attainment and owner-occupied housing were positively associated with both outcomes. Notably, increased residential stability (aOR 5.68, 95% CI 2.93, 9.04) was positively associated with HIV care engagement, as were unemployment (aOR: 1.59, 95% CI 1.57, 1.60), lack of car ownership (aOR 1.14, 95% CI 1.13, 1.15), and female-headed households (aOR 1.23, 95% CI 1.22, 1.23). This underscores the importance of understanding neighborhood context, including factors that may not always be considered influential, in achieving optimal HIV-related outcomes.