Geographic disparities in late HIV diagnoses in Tennessee: Opportunities for interventions in the rural Southeast

Author:

Gibas Kevin M.12ORCID,Rebeiro Peter F.34,Brantley Meredith5,Mathieson Samantha5,Maurer Laurie5,Pettit April C.6

Affiliation:

1. Department of Medicine Warren Alpert Medical School of Brown University Providence Rhode Island USA

2. Department of Epidemiology & Infection Prevention Rhode Island Hospital Providence Rhode Island USA

3. Division of Epidemiology Department of Medicine Vanderbilt University School of Medicine Nashville Tennessee USA

4. Department of Medicine and Department of Biostatistics Division of Infectious Diseases Vanderbilt University School of Medicine Nashville Tennessee USA

5. Section of HIV, Sexually Transmitted Infections, and Viral Hepatitis Tennessee Department of Health Nashville Tennessee USA

6. Department of Medicine Vanderbilt University Medical Center Nashville Tennessee USA

Abstract

AbstractPurposeIncident HIV remains an important public health issue in the US South, the region leading the nation in HIV incidence, rural HIV cases, and HIV‐related deaths. Late diagnoses drive incident HIV and understanding factors driving late diagnoses is critical for developing locally relevant HIV testing and prevention interventions, decreasing HIV transmission, and ending the HIV epidemic.MethodsRetrospective cohort study utilizing Tennessee Department of Health (TDH) surveillance data and US Census Bureau data. Adults of ≥18‐year old with a new HIV diagnosis between January 1, 2015 and December 31, 2019 identified in the TDH electronic HIV/AIDS Reporting System were included. Individuals were followed from initial HIV diagnosis until death, 90 days of follow‐up for outcome assessment, or administrative censoring 90 days after study enrollment closed.FindingsWe included 3652 newly HIV‐diagnosed individuals; median age was 31 years (IQR: 25, 42), 2909 (79.7%) were male, 2057 (56.3%) were Black, 246 (6.7%) were Hispanic, 408 (11.2%) were residing in majority‐rural areas at diagnosis, and 642 (17.6%) individuals received a late HIV diagnosis. Residents of majority‐rural counties (adjusted risk ratios [aRR] = 1.39, 95% confidence intervals [CI]: 1.16–1.67) and Hispanic individuals (aRR = 1.87, 95% CI: 1.50–2.33) had an increased likelihood of receiving a late diagnosis after controlling for race/ethnicity, age, and year of HIV diagnosis.ConclusionsRural residence and Hispanic ethnicity were associated with an increased risk of receiving a late HIV diagnosis in Tennessee. Future HIV testing and prevention efforts should be adapted to the needs of these vulnerable populations.

Funder

National Institute of Mental Health

Publisher

Wiley

Reference67 articles.

1. Centers for Disease Control & Prevention.HIV in the Southern United States—Centers for disease control and prevention.CDC.gov;2019.https://www.cdc.gov/hiv/pdf/policies/cdc‐hiv‐in‐the‐south‐issue‐brief.pdf

2. Centers for Disease Control & Prevention.HIV surveillance in urban and Nonurban areas 2018 (preliminary).CDC.gov;2018.https://www.cdc.gov/hiv/pdf/library/slidesets/cdc‐hiv‐surveillance‐urban‐nonurban‐2018.pdf

3. Revised surveillance case definition for HIV infection — United States.CDC.gov;2014. Accessed December 7 2022.https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6303a1.htm?s_cid=rr6303a1_e

4. AIDSVu Tennessee. AIDSVu. Accessed January 30 2023.https://aidsvu.org/local‐data/united‐states/south/tennessee/

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