Individual, Community, and Structural Factors Associated With Linkage to HIV Care Among People Diagnosed with HIV in Tennessee

Abstract

Background We assessed trends and identified individual- and county-level factors associated with linkage to HIV care in Tennessee (TN). Methods TN residents diagnosed with HIV from 2012–2016 were included in the analysis (n = 3,750). Linkage was defined by the first CD4 or HIV RNA test date at or after HIV diagnosis. We used modified Poisson regression to estimate probability of 30-day linkage to care at the individual- and county-levels. Results Both MSM (aRR 1.16, 95%CI 1.01–1.32) and women who reported heterosexual sex risk factors (aRR 1.28, 95%CI 1.11–1.48) were more likely to link to care within 30-days than heterosexual males. Non-Hispanic Black individuals had poorer linkage than White individuals (aRR 0.77, 95%CI 0.72–0.83). County-level mentally unhealthy days were negatively associated with linkage (aRR 0.59, 95%CI 0.40–0.88). Conclusions Disparities persist at both individual and county levels and may warrant structural interventions to address racism and mental health needs.

Characterizing residential mobility among people with HIV in Tennessee and its impact on HIV care outcomes

“…Tennessee has underperformed relative to the US population in key steps along the HIV care continuum [11][12][13]. This trend has persisted despite concerted efforts by the Tennessee Department of Health (TDH) to improve these outcomes, leaving Tennessee with a challenge to reach EHE goals of prompt diagnosis, treatment initiation, and long-term care engagement [12,14,15]. To address gaps in the literature around mobility and HIV in the United States, we assessed the prevalence and patterns of mobility among PWH in Tennessee in 1 year and the impact of mobility on HIV care continuum outcomes in the subsequent calendar year.…”