Disparities in HIV Linkage and Receipt of Care within Atlanta Open Access
Johnson, Eric (Summer 2025)
Abstract
Background
HIV has posed a significant public health threat in the United States for over forty years. Atlanta, Georgia, one of the largest metropolitan areas in the South, is at the epicenter of new HIV diagnoses in the region. Although Black/African American individuals make up 33% of Atlanta’s population, they account for 69% of new HIV diagnoses annually. Linkage to care (LTC) and receipt of care (ROC), following diagnosis, are critical steps in HIV management.
Objective
This study aimed to evaluate associations between LTC and ROC outcomes and key social determinants of health (SDOH) at the zip-code level in Atlanta, with a focus on racial disparities in LTC and ROC.
Methods
Zip code level HIV and SDOH data were sourced from the AIDSVu 2022 Atlanta dataset. LTC was defined as HIV intervention within a month of diagnosis and ROC defined as HIV intervention in the given year. Using unadjusted and adjusted linear regression and negative binomial regression, we measured the association between zip code level SDOH and zip code level LTC/ROC percentages and counts, respectively, stratified by race (Black, White, and Total).
Results
The LTC and ROC analyses included 61 and 145 zip codes, respectively. 77.1% Black and 82.1% White populations diagnosed with HIV were linked to care; 77.7% and 81.6%, respectively, received care. Linear regression showed that among Black cases, higher severe housing burden and greater median household income were significantly associated with higher LTC (housing burden 1.48%, p = 0.0025; household income 0.0002%, p = 0.0321). Negative binomial models showed that people in a zip code with less than a high school education was associated with 7.0% (Black) and 5.1% (White) lower LTC cases, and 8.75% (Black) and 5.2% (White) lower ROC cases.
Conclusions
Zip code level education-related social determinants of health were strongly associated with reduced HIV linkage to and receipt of care, particularly among African American populations. Other SDOH factors, such as income and housing burden, showed less consistent effects. With some findings displaying no significant effects at all. Further research is needed to refine analysis and address structural barriers to HIV care, especially for marginalized groups in the Southern U.S.
Table of Contents
Table of Contents
Introduction ……………………………………………………………. 7
Methods ………………………………………………………………….. 8
Data Source ………………………………………………………………. 8
Exposures …………………………………………………………………. 8
Outcomes …………………………………………………………………. 8
Data Analysis ……………………………………………………………. 9
Results …………………………………………………………………….. 9
Demographics and Characteristics …………………………. 9
Linear Regression: Linkage to Care ……………………….. 12
Linear Regression: Receipt of Care ……………………….. 13
Collinearity Testing ………………………………………………… 13
Binomial Regression: Individual Models ……………….. 14
Final Linkage to Care Models ……………………………….. 16
Final Receipt of Care Models ……………………………….. 16
Sensitivity Analysis ………………………………………………… 17
Discussion ……………………………………………………………….. 18
Conclusion ………………………………………………………………. 19
References ………………………………………………………………. 21
About this Master's Thesis
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Disparities in HIV Linkage and Receipt of Care within Atlanta () | 2025-07-30 04:24:20 -0400 |
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