Associations Between Sociodemographic Factors and Retention in HIV Care Among Black and White MSM in Atlanta, Georgia Open Access

Forshag, Margaret (Spring 2018)

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Retention in care provides an opportunity for prescription of antiretroviral therapy (ART), ART adherence counselling, and routine lab testing of viral load and ART resistance, and has been associated with higher rates of viral suppression and lower risk of mortality. Improving retention in care is a global and national priory, and is part of the US National HIV/AIDS Prevention Goals and UN 90-90-90 Goals. Despite the importance of retention, however, only 56.9% of people with diagnosed HIV were retained in care in 2014. Previous studies have also found a racial disparity of retention in care, with black people living with HIV (PLWH) having lower rates of retention compared to white PLWH. We used baseline data from a cohort of 207 black and 193 white HIV-positive MSM in Atlanta to explore the associations between demographic and social factors and retention in HIV care. We used multivariable logistic regression modeling to estimate these associations. Because of known racial disparities in HIV care outcomes, we also stratified our model to examine differences in those associations by race. Overall, retention rates were 81% of black participants and 84% of white participants. Having health insurance and higher level of education were statistically significantly associated with higher retention in HIV care (Insurance OR: 2.39; 95% CI: 1.26, 4.52; Education OR: 2.08; 95% CI 1.03, 4.18). The association between having health insurance and retention varied by race (black OR: 4.94; 95% CI 1.98, 12.29; white OR 0.96; 95% CI: 0.34, 2.73). Our results suggest that the associations between sociodemographic factors and retention in care may vary by race. A more nuanced understanding of the race-specific factors that impact retention could help HIV care providers more effectively target the populations with the most risk, bringing us closer to the goal of 90% retention in care by 2020.

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