Patients with HIV in Southern hospitals were less likely to be virally suppressed or engaged in care compared with patients from non-Southern hospitals, according to findings published in Clinical Infectious Diseases.
“Few studies have examined regional differences in access to HIV-related care and outcomes,” Morgan M. Philbin, PhD, MHS, assistant professor of sociomedical sciences at the Columbia University Mailman School of Public Health, and colleagues wrote.
“The CDC has identified the South as the new epicenter of the HIV epidemic in the United States. Data suggest that Southern states tend to have lower rates of care linkage and engagement than those in the North or Midwest, and higher HIV-related mortality and poorer survival. Identifying geographic differences in treatment and care outcomes could assist policymakers in tailoring interventions, updating policies and determining areas of greatest need.”
Philbin and colleagues analyzed data from the National Institute on Drug Abuse Clinical Trials Network 0049 study, which took place between July 2012 and January 2014 and included 2,291 HIV-infected patients recruited from 11 hospitals across the U.S. with a large number of HIV patients and a high prevalence of substance abuse among this population. The Southern locations included Atlanta; Baltimore; Birmingham, Alabama; Dallas and Miami. The other sites included
Boston, Chicago, Los Angeles, New York, Philadelphia and Pittsburgh. The analysis included private and public hospitals.
Of the 1,227 patients included in the analyses, 557 came from the Southern cohort. Men made up just over two-thirds of the participants. Around two-thirds (66%) of the participants were black, and the median age of the patients was 48 years.
Most participants reported an annual income of $20,000 or less, stable housing and health insurance. Just over half had ever used drugs, with 40% reporting having attended substance abuse treatment in the last year.
A high percentage (88%) reported having ever been in HIV care, with 90% reporting a visit within the past year. Most (80%) were on ART, 49% had a CD4+ cell count of less than 200 cells/µgL and 43% were virally suppressed, Philbin and colleagues reported.
When Southern vs. non-Southern sites were compared, participants in the Southern locations were younger (45.8 years vs. 47.5 years) and more were black (70.9% vs. 62.6%), disabled (55.7% vs. 43.8%) or uninsured (23.6% vs. 17.1%).
According to the researchers, patients in the South were less likely to report substance use (44.6% vs. 59.4%) or problematic drug or alcohol use (45.8% vs. 60%) or to have been treated for substance use (38.6% vs. 50.5%). But 12.7% reported not having had an HIV care visit within the past 12 months, compared with 8.2% of non-Southern patients. They were more likely to have a CD4+ cell count of less than 200 cells/µgL than patients in other regions (55.1% vs. 43.4%) but were less likely to be virally suppressed (35.3% vs. 40.3%).
“Almost two-thirds of HIV-infected participants recruited from the Southern hospitals presented with a detectable viral load compared with half of participants in the non-Southern hospitals,” the researchers wrote.
“While we cannot infer the reasons for this difference in viral suppression, the majority of participants were low-income ethnic/racial minorities who faced multiple health disparities, including unstable housing, food insecurity, unemployment, disability and education level. These problems may be particularly acute in Southern sites, where social safety net programs to address these issues may be especially underfunded or unavailable.”
They said the findings “are consistent with other research that has shown HIV resources, Medicaid and social safety net programs that may benefit populations at high risk for HIV are generally underfunded in the South as compared to other parts of the U.S.” – by Bruce Thiel
Philbin reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.