title: Individual and community factors associated with geographic clusters of poor HIV care retention and poor viral suppression.
abstract: BACKGROUND
  Previous analyses identified specific geographic areas in Philadelphia (hotspots) associated with negative outcomes along the HIV care continuum. We examined individual and community factors associated with residing in these hotspots.
  
  
  METHODS
  Retrospective cohort of 1404 persons newly diagnosed with HIV in 2008-2009 followed for 24 months after linkage to care. Multivariable regression examined associations between individual (age, sex, race/ethnicity, HIV transmission risk, and insurance status) and community (economic deprivation, distance to care, access to public transit, and access to pharmacy services) factors and the outcomes: residence in a hotspot associated with poor retention-in-care and residence in a hotspot associated with poor viral suppression.
  
  
  RESULTS
  In total, 24.4% and 13.7% of persons resided in hotspots associated with poor retention and poor viral suppression, respectively. For persons residing in poor retention hotspots, 28.3% were retained in care compared with 40.4% of those residing outside hotspots (P < 0.05). Similarly, for persons residing in poor viral suppression hotspots, 51.4% achieved viral suppression compared with 75.3% of those outside hotspots (P < 0.0.05). Factors significantly associated with residence in poor retention hotspots included female sex, lower economic deprivation, greater access to public transit, shorter distance to medical care, and longer distance to pharmacies. Factors significantly associated with residence in poor viral suppression hotspots included female sex, higher economic deprivation, and shorter distance to pharmacies.
  
  
  CONCLUSIONS
  Individual and community-level associations with geographic hotspots may inform both content and delivery strategies for interventions designed to improve retention-in-care and viral suppression.
authors: *Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA; †Department of Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania Philadelphia Veterans Affairs Center for Health Equity Research and Promotion, Philadelphia, PA; ‡Department of City and Regional Planning, School of Design, University of Pennsylvania, Philadelphia, PA; Departments of §Psychiatry; ‖Medicine, Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and ¶University of Pennsylvania, Treatment Research Institute, Philadelphia, PA.
authors: Michael G
authors: MG
authors: Eberhart
authors: Baligh R
authors: BR
authors: Yehia
authors: Amy
authors: A
authors: Hillier
authors: Chelsea D
authors: CD
authors: Voytek
authors: Danielle J
authors: DJ
authors: Fiore
authors: Michael
authors: M
authors: Blank
authors: Ian
authors: I
authors: Frank
authors: David S
authors: DS
authors: Metzger
authors: Kathleen A
authors: KA
authors: Brady
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003266:Continuity of Patient Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D012111:Residence Characteristics; D012189:Retrospective Studies; D062206:Spatial Analysis; D019562:Viral Load