title: Understanding Determinants of Racial and Ethnic Disparities in Viral Load Suppression.
abstract: Racial and ethnic disparities in viral load suppression (VLS) have been well documented among people living with HIV (PLWH). The authors hypothesized that a contemporary analytic technique could reveal factors underlying these disparities and provide more explanatory power than broad stereotypes. Classification and regression tree analysis was used to detect factors associated with VLS among 11 419 adult PLWH receiving treatment from 186 New York State HIV clinics in 2013. A total of 8885 (77.8%) patients were virally suppressed. The algorithm identified 8 mutually exclusive subgroups characterized by age, housing stability, drug use, and insurance status but neither race nor ethnicity. Our findings suggest that racial and ethnic disparities in VLS exist but likely reflect underlying social and behavioral determinants of health.
authors.affiliation: 1 New York State Department of Health AIDS Institute, New York, NY, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Feller
authors.affiliation: 1 New York State Department of Health AIDS Institute, New York, NY, USA.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Agins
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D019380:Anti-HIV Agents / Q000627:therapeutic use; D055030:Drug Users; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D054625:Healthcare Disparities; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D000072230:Sustained Virologic Response; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: adherence; disparities; inequalities; quality improvement; viral load suppression