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

Abstract

Objective: Our objective was to assess the prevalence and patterns of mobility among people with HIV (PWH) in Tennessee and its impact on HIV care outcomes. Design: Retrospective cohort study. Methods: We combined residential address and HIV surveillance data from PWH in Tennessee from 2016 to 2018. Using Poisson regression, we estimated associations between in-state mobility (change in address or total miles moved) in 1 year and outcomes in the subsequent year; retention: having two CD4+/HIV RNA values (labs) in a calendar year at least 3 months apart, loss to follow-up (LTFU): having labs at baseline but not the subsequent year, and viral suppression: HIV RNA less than 200 copies/ml. We applied a kernel density estimator to origin-destination address lines to visualize mobility patterns across demographic subgroups. Results: Among 17 428 PWH [median age 45 years (interquartile range; IQR 34–53)], 6564 (38%) had at least one move. Median miles moved was 8.9 (IQR 2.6–143.4)). We observed in-state movement between major cities (Chattanooga, Knoxville, Memphis and Nashville) and out-of-state movement to and from Georgia and Florida. Having at least one in-state move was associated with a decreased likelihood of retention [adjusted relative risk (aRR) = 0.91; 95% confidence interval (CI) 0.88–0.95], and an increased risk of LTFU (aRR = 1.17; 95% CI 1.04–1.31, two to three moves vs. none). Greater distance moved in-state was associated with decreased retention and increased LTFU (aRR = 0.53; 95% CI 0.49–0.58, aRR = 2.52; 95% CI 2.25–2.83, respectively for 1000 vs. 0 miles). There was no association between mobility and viral suppression. Conclusion: Mobility is common among PWH in Tennessee and is associated with initial poor engagement in HIV care.