Since delayed initiation of human immunodeficiency virus (HIV) care affects the disease’s progression, researchers at Florida International University examined the role of HIV testing sites, along with neighborhood- and individual-level factors in racial/ethnic disparities in initiation of care.
Dr. Mary Jo Trepka, professor in Florida International University (FIU) Robert Stempel College of Public Health and Social Work’s department of epidemiology and leader of the FIU-RCMI Investigator Development Core, published “Racial/Ethnic Disparities in Failure to Initiate HIV Care: Role of HIV Testing Site, Individual Factors, and Neighborhood Factors, Florida, 2014–2015” in the August issue of the Journal of Health Care for the Poor and Underserved.
By analyzing, Florida population-based HIV/AIDS surveillance system records, Dr. Trepka and her colleagues found that “the adjusted prevalence ratios for non-initiation of care for non-Hispanic Blacks relative to non-Hispanic Whites was 1.57 (95 percent confidence interval [CI] 1.38–1.78) and for those tested in plasma/donation centers relative to outpatient clinics was 2.45 (95 percent CI 2.19–2.74).” The study noted that testing sites and individual variables are factors in racial and ethnic disparities in non-initiation of HIV care. Linkage procedures, particularly at plasma/blood donation centers, warrant improvement.
This study, part of a larger project examining racial/ethnic disparities in HIV mortality, was funded by the National Institutes of Minority Health and Health Disparities as an National Institutes of Health Research Project Grant Program R01.
For the larger project, the team initially examined mortality before realizing that they needed to start looking at the steps along the HIV continuum of care, which include being diagnosed for HIV infection, being linked to care, being retained in care, receiving antiretroviral therapy and being virally suppressed.
The findings of this study are particularly important, as the team discovered that people whose HIV infection was identified through a blood bank or plasma center are especially likely not to be linked to care. Further study is required to determine why these testing sites display these particular results, but it may be related to the information not getting to the patient, their being in denial, or that they receive little to no assistance in finding a provider to care for their HIV infection.
Additionally, the team found that African Americans were less likely to be linked to HIV care. In earlier work, Dr. Trepka and her colleagues found that African Americans in Florida had a higher risk of death once diagnosed with HIV compared to Non-Hispanic Whites. One of the reasons for the increased mortality may include the problems related to linkage to care. However, the team found that there are disparities in retention in care and viral suppression in other studies. Therefore, the racial/ethnic disparities seen in mortality are likely due to barriers at multiple stages of the HIV care continuum.
“Linkage to care is the first step after diagnosis, and it is not as easy as one might think. There are many reasons why a person might not access care once diagnosed including psychologic barriers, such as denial, to structural barriers, such as impeding access health care,” said Dr. Trepka. “Because HIV care and treatment and the resulting viral suppression cannot occur until there is linkage to care, it is a very important step in the care continuum.”
Among people with HIV infection, viral suppression leads to improved health and reduced mortality and results in a person with HIV infection becoming essentially noncommunicable. Therefore, widespread care, treatment and successful viral suppression in a community can help reduce the rate of new HIV infections.