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. 2024 Mar 9;24(1):749.
doi: 10.1186/s12889-024-17944-w.

Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019

Shannan N Rich #  1 , Yiyang Liu #  2 , Rebecca Fisk-Hoffman  1 , Yi Zheng  3 , Hui Hu  3 , Emma E Spencer  4 , Robert L Cook  1 , Mattia Prosperi  1
Affiliations

Spatial and temporal analysis of HIV clinical outcomes in Florida reveals counties with persistent racial and ethnic disparities during 2012-2019

Shannan N Rich et al. BMC Public Health. .

Abstract

Background: Racial/ethnic disparities in the HIV care continuum have been well documented in the US, with especially striking inequalities in viral suppression rates between White and Black persons with HIV (PWH). The South is considered an epicenter of the HIV epidemic in the US, with the largest population of PWH living in Florida. It is unclear whether any disparities in viral suppression or immune reconstitution-a clinical outcome highly correlated with overall prognosis-have changed over time or are homogenous geographically. In this analysis, we 1) investigate longitudinal trends in viral suppression and immune reconstitution among PWH in Florida, 2) examine the impact of socio-ecological factors on the association between race/ethnicity and clinical outcomes, 3) explore spatial and temporal variations in disparities in clinical outcomes.

Methods: Data were obtained from the Florida Department of Health for 42,369 PWH enrolled in the Ryan White program during 2008-2020. We linked the data to county-level socio-ecological variables available from County Health Rankings. GEE models were fit to assess the effect of race/ethnicity on immune reconstitution and viral suppression longitudinally. Poisson Bayesian hierarchical models were fit to analyze geographic variations in racial/ethnic disparities while adjusting for socio-ecological factors.

Results: Proportions of PWH who experienced viral suppression and immune reconstitution rose by 60% and 45%, respectively, from 2008-2020. Odds of immune reconstitution and viral suppression were significantly higher among White [odds ratio =2.34, 95% credible interval=2.14-2.56; 1.95 (1.85-2.05)], and Hispanic [1.70 (1.54-1.87); 2.18(2.07-2.31)] PWH, compared with Black PWH. These findings remained unchanged after accounting for socio-ecological factors. Rural and urban counties in north-central Florida saw the largest racial/ethnic disparities.

Conclusions: There is persistent, spatially heterogeneous, racial/ethnic disparity in HIV clinical outcomes in Florida. This disparity could not be explained by socio-ecological factors, suggesting that further research on modifiable factors that can improve HIV outcomes among Black and Hispanic PWH in Florida is needed.

Keywords: Clinical outcomes; HIV; HIV in the South; Racial disparities; Spatial-temporal epidemiology.

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Conflict of interest statement

Liu and Prosperi receive research grant funding from Merck through Merck Investigator Studies Program. No potential conflict of interest was reported by other authors.

Figures

Fig. 1
Fig. 1
Longitudinal proportions of immune reconstitution and viral suppression overall (Panel A) and by race/ethnicity (Panels B and C) in Florida annually, from 2012 – 2019
Fig. 2
Fig. 2
Map of the spatial variations in the relative risk of non-reconstitution (left) and non-suppression (right) among Black vs Non-Black PWH in Florida, 2012 – 2019. Relative risks above 1.0 indicate counties where the risk of non-reconstitution or non-suppression is significantly higher among Black PWH compared to non-Black PWH
See this image and copyright information in PMC

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