AIDS and Behavior

, Volume 21, Issue 12, pp 3557–3566 | Cite as

Neighborhood Characteristics Associated with Achievement and Maintenance of HIV Viral Suppression Among Persons Newly Diagnosed with HIV in New York City

  • Ellen W. Wiewel
  • Luisa N. Borrell
  • Heidi E. Jones
  • Andrew R. Maroko
  • Lucia V. Torian
Original Paper

Abstract

We investigated the effect of neighborhood characteristics on achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older diagnosed between 2006 and 2012. Individual records from the NYC HIV surveillance registry (n = 12,547) were linked to U.S. Census and American Community Survey data by census tract of residence. Multivariable proportional hazards regression models indicated the likelihood of achievement and maintenance of suppression by neighborhood characteristics including poverty, accounting for neighborhood clustering and for individual characteristics. In adjusted analyses, no neighborhood factors were associated with achievement of suppression. However, residents of high- or very-high-poverty neighborhoods were less likely than residents of low-poverty neighborhoods to maintain suppression. In conclusion, higher neighborhood poverty was associated with lesser maintenance of suppression. Assistance with post-diagnosis retention in care, antiretroviral therapy prescribing, or adherence targeted to residents of higher-poverty neighborhoods may improve maintenance of viral suppression in NYC.

Resumen

Se evaluaron las características del vecindario con relación al logro inicial y mantenimiento de la supresión de la carga viral de VIH, entre personas de 13 años de edad o más, que residen en la Ciudad de Nueva York, y que fueron diagnosticados con VIH entre el año 2006 y el 2012. Los archivos individuales (n = 12547) del registro de vigilancia de VIH de la Ciudad de Nueva York fueron vinculados con los datos del Censo de los Estados Unidos y de la Encuesta sobre la Comunidad Estadounidense por sección censal de residencia. Modelos multivariables de regresión de Cox mostraron la asociación del logro inicial de la supresión de la carga viral y su mantenimiento con características de vecindario incluyendo la pobreza, teniendo en cuenta la agrupación de vecindarios y características individuales. En análisis ajustados, no se encontró ningún factor de los vecindarios asociado con el logro inicial de la supresión. Sin embargo, los residentes de vecindarios con alto o muy alto nivel de pobreza tuvieron menos probabilidad de mantener la supresión, que los residentes de vecindarios con un nivel de pobreza bajo. En conclusión, los residentes de vecindarios con altos niveles de pobreza tuvieron un menor mantenimiento de la supresión de la carga viral. Asistencia con la retención de cuidado médico posterior al diagnóstico, la prescripción de terapia antirretroviral, o adherencia al tratamiento, que es dirigida a los residentes de vecindarios de altos niveles de pobreza, podría mejorar el mantenimiento de la supresión viral en la Ciudad de Nueva York.

Notes

Acknowledgements

We thank Dr. Qiang Xia for sharing SAS code and exclusion criteria related to measuring viral suppression among persons newly diagnosed with HIV, and laboratory reporting completeness estimates. For their geocoding of data on the residences of New Yorkers with HIV, we are indebted to Heidi Westermann Gortakowski, Hani Nasrallah, and Dr. Arpi Terzian. We thank Susan Resnick for providing the network dataset for the network analysis of distance between place of residence and medical facility. Drs. Sarah Braunstein, Demetre Daskalakis, Kent Sepkowitz, and Mary Irvine provided helpful suggestions in the writing of the manuscript. We are grateful to Eleonora Jimenez-Levi and Dr. Luis Roberto Rodríguez-Porras for their assistance in the Spanish translation of the abstract.

Compliance with Ethical Standards

Conflicts of interest

The authors have no potential conflicts of interest to disclose.

Ethical Approval

Ethical approval for these analyses was provided by the Institutional Review Boards of Lehman College of the City University of New York and of the New York City Department of Health and Mental Hygiene. These were secondary analyses of existing data. No recruitment, consent, interaction or intervention occurred with human subjects. The analyses did not involve animals.

Supplementary material

10461_2017_1700_MOESM1_ESM.docx (34 kb)
Supplementary material 1 (DOCX 34 kb)

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Ellen W. Wiewel
    • 1
  • Luisa N. Borrell
    • 2
  • Heidi E. Jones
    • 2
  • Andrew R. Maroko
    • 2
  • Lucia V. Torian
    • 1
  1. 1.Division of Disease ControlNew York City Department of Health and Mental HygieneLong Island CityUSA
  2. 2.CUNY Graduate School of Public Health and Health PolicyNew YorkUSA

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