Place-based predictors of HIV viral suppression and durable suppression among heterosexuals in New York city.

Scant research has explored place-based correlates of achieving and maintaining HIV viral load suppression among heterosexuals living with HIV. We conducted multilevel analyses to examine associations between United Hospital Fund (UHF)-level characteristics and individual-level viral suppression and durable viral suppression among individuals with newly diagnosed HIV in New York City (NYC) who have heterosexual HIV transmission risk. Individual-level independent and dependent variables came from NYC's HIV surveillance registry for individuals diagnosed with HIV in 2009-2013 (N = 3,159; 57% virally suppressed; 36% durably virally suppressed). UHF-level covariates included measures of food distress, demographic composition, neighborhood disadvantage and affluence, healthcare access, alcohol outlet density, residential vacancy, and police stop and frisk rates. We found that living in neighborhoods where a larger percent of residents were food distressed was associated with not maintaining viral suppression. If future research should confirm this is a causal association, community-level interventions targeting food distress may improve the health of people living with HIV and reduce the risk of forward transmission.

Place-Based Predictors of HIV Viral Suppression and Durable Suppression Among Men Who Have Sex With Men in New York City.

We explore relationships between place characteristics and HIV viral suppression among HIV-positive men who have sex with men (MSM) in New York City (NYC). We conducted multilevel analyses to examine associations of United Hospital Fund (UHF)-level characteristics to individual-level suppression and durable suppression among MSM. Individual-level independent and dependent variables came from MSM in NYC's HIV surveillance registry who had been diagnosed in 2009-2013 (N = 7159). UHF-level covariates captured demographic composition, economic disadvantage, healthcare access, social disorder, and police stop and frisk rates. 56.89% of MSM achieved suppression; 35.49% achieved durable suppression. MSM in UHFs where 5-29% of residents were Black had a greater likelihood of suppression (reference: ≥30% Black; adjusted relative risk (ARR) = 1.07, p = 0.04). MSM in UHFs with <30 MSM-headed households/10,000 households had a lower likelihood of achieving durable suppression (reference: ≥60 MSM-headed households/10,000; ARR = 0.82; p = 0.05). Place characteristics may influence viral suppression. Longitudinal research should confirm these associations.

The Association Between Neighborhood Poverty and HIV Diagnoses Among Males and Females in New York City, 2010-2011.

OBJECTIVE: We assessed the association of neighborhood poverty with HIV diagnosis rates for males and females in New York City. METHODS: We calculated annual HIV diagnosis rates by ZIP Code, sex, and neighborhood poverty level using 2010-2011 New York City (NYC) HIV surveillance data and data from the U.S. Census 2010 and American Community Survey 2007-2011. Neighborhood poverty levels were percentage of residents in a ZIP Code with incomes below the federal poverty threshold, categorized as 0%-<10% (low poverty), 10%-<20% (medium poverty), 20%-<30% (high poverty), and 30%-100% (very high poverty). We used sex-stratified negative binomial regression models to measure the association between neighborhood-level poverty and HIV diagnosis rates, controlling for neighborhood-level education, race/ethnicity, age, and percentage of men who have sex with men. RESULTS: In 2010-2011, 6,184 people were newly diagnosed with HIV. Median diagnosis rates per 100,000 population increased by neighborhood poverty level overall (13.7, 34.3, 50.6, and 75.6 for low-, medium-, high-, and very high-poverty ZIP Codes, respectively), for males, and for females. In regression models, higher neighborhood poverty remained associated with higher diagnosis rates among males (adjusted rate ratio [ARR] = 1.63, 95% confidence interval [CI] 1.34, 1.97) and females (ARR=2.14, 95% CI 1.46, 3.14) for very high- vs. low-poverty ZIP Codes. CONCLUSION: Living in very high- vs. low-poverty urban neighborhoods was associated with increased HIV diagnosis rates. After controlling for other factors, the association between poverty and diagnosis rates was stronger among females than among males. Alleviating poverty may help decrease HIV-related disparities.

Comparison of indicators measuring the proportion of human immunodeficiency virus-infected persons with a suppressed viral load.

PURPOSE: The Centers for Disease Control and Prevention uses the last viral load to estimate the proportion of human immunodeficiency virus (HIV)-infected persons with a suppressed viral load. Several recent studies report that it may overestimate viral suppression in the population and have suggested using sustained viral suppression. The objective of this analysis is to compare these indicators. METHODS: Using New York City HIV surveillance data, two indicators were compared with a new one, weighted viral suppression, which accounts for both the status and duration of viral suppression. RESULTS: Among 72,315 HIV-infected persons with at least one viral load measurement in New York City in 2013, 62,829 had at least one suppressed viral load, 58,041 had a suppressed last viral load, and 47,948 had sustained viral suppression. Compared with the weighted proportion (77.5%), the proportion based on last viral load suppression (80.3%) was slightly higher, and the proportion based on sustained viral suppression (66.3%) was substantially lower. CONCLUSIONS: The indicator based on last viral load suppression is the most straightforward to calculate and understand and also approximates the weighted indicator, which measures viral suppression for the entire analysis period. Therefore, we support using the indicator based on last viral load suppression to monitor the National HIV/AIDS Strategy.

Proportions of patients with HIV retained in care and virally suppressed in New York City and the United States: higher than we thought.

BACKGROUND: The purpose of this analysis is to compare 2 newly developed methods (a "likelihood" method and a "weighting" method) with the widely used method (the "include-all" method) to estimate the proportions of HIV-infected persons retained in care and virally suppressed in New York City (NYC). METHODS: The NYC HIV registry data were used for the analysis. The include-all method included all patients in the denominator who were diagnosed and/or receiving care in NYC and not known to be dead by December 31, 2012. The likelihood method included patients in the denominator who were likely to reside in NYC in 2012 based on their length of absence from HIV care. The weighting method included patients in the denominator who were residing in NYC in 2012 by weighting each in-care patient based on their probability of receiving HIV care. RESULTS: The include-all method estimated that 114,926 persons were diagnosed and living with HIV in NYC, 63.7% were retained in care (≥1 care visit in 2012), and 48.9% were virally suppressed (≤200 copies/mL). The likelihood method and the weighting method produced equivalent estimates with 80,074 and 80,509 persons diagnosed and living with HIV in NYC, 91.5% and 91.0% retained in care, and 70.2% and 71.7% virally suppressed, respectively. CONCLUSIONS: Using 2 newly developed methods, we were able to report more accurate estimates of the proportions of patients retained in care and virally suppressed. Other local health jurisdictions should consider using these new methods to measure care outcomes and monitor the National HIV/AIDS Strategy.