Access to Federally Qualified Health Centers and HIV Outcomes in the U.S. South

Abstract

Introduction: Federally Qualified Health Centers may increase access to HIV prevention, care, and treatment for at-risk populations.

Methods: A pooled cross section of ZIP Code Tabulation Areas from cites in the U.S. South with high HIV diagnoses were used to examine Federally Qualified Health Center density and indicators of HIV epidemic control. The explanatory variable was Federally Qualified Health Center density-number of Federally Qualified Health Centers in a ZIP Code Tabulation Areas' Primary Care Service Area per low-income population-high versus medium/low (2019). Outcomes were 5-year (2015-2019 or 2014-2018) (1) number of new HIV diagnoses, (2) percentage late diagnosis, (3) percentage linked to care, and (4) percentage virally suppressed, which was assessed over 1 year (2018 or 2019). Multiple linear regression was used to examine the relationship, including ZIP Code Tabulation Area-level sociodemographic and city-level HIV funding variables, with state-fixed effects, and data analysis was completed in 2022-2023. Sensitivity analyses included (1) examining ZIP Code Tabulation Areas with fewer non-Federally Qualified Health Center primary care providers, (2) controlling for county-level primary care provider density, (3) excluding the highest HIV prevalence ZIP Code Tabulation Areas, and (4) excluding Florida ZIP Code Tabulation Areas.

Results: High-density ZIP Code Tabulation Areas had a lower percentage of late diagnosis and virally suppressed, a higher percentage linked to care, and no differences in new HIV diagnoses (p<0.05). In adjusted analysis, high density was associated with a greater number of new diagnoses (number or percentage=5.65; 95% CI=2.81, 8.49), lower percentage of late diagnosis (-3.71%; 95% CI= -5.99, -1.42), higher percentage linked to care (2.13%; 95% CI=0.20, 4.06), and higher percentage virally suppressed (1.87%; 95% CI=0.53, 2.74) than medium/low density.

Conclusions: Results suggest that access to Federally Qualified Health Centers may benefit community-level HIV epidemic indicators.

Figure 1.

ZCTA Sample Derivation Abbreviations: Dx – diagnosis; ZCTA – Zip Code Tabulation Area

Figure 2.

Summary of Analyses, HIV Epidemic Indicators and FQHC Density in Southern Urban ZCTAs ^a,b,c,d Abbreviations: FQHC – Federally Qualified Health Center; PCP – Primary Care Provider; ZCTA – Zip Code Tabulation Area ^a High density ZCTAs were defined as those ZCTAs with ≥ 75^th percentile Primary Care Service Area (PCSA) FQHC density (≥1.182 FQHCs per 10,000 PCSA low-income population); medium density was defined as those ZCTAs with <75^th and ≥ 25^th percentile PCSA FQHC density (<1.182, ≥0.069); low density was defined as those ZCTAs with <25^th percentile PCSA FQHC density (<0.069). ^b a filled circle (•) indicates results are significant at a value p<0.05 ^c The x-axis represents a count for number of new HIV diagnoses, a negative percent (i.e., lower) for late HIV diagnosis, and a positive percent for linked to care and virally suppressed. ^d New HIV diagnoses, percent late diagnosis, and percent linked to care represent a 5-year period (2014–2019 or 2015–2019); percent virally suppressed represents a 1-year period (2018 or 2019).