Factors associated with HIV prevalence among persons experiencing homelessness in Fulton County, Atlanta Public

Abstract

 

People who experience homelessness in the US are a high-risk group for HIV and are more adversely affected than the general population. This retrospective review of medical records evaluated factors associated with HIV prevalence among homeless persons in Fulton County, Atlanta to better inform health programs run by the Fulton County Board of Health (FCBOH). This study had two outcomes: 1) Self-reported or laboratory-confirmed HIV positive status and 2) Only laboratory-confirmed HIV positive status. This study included 3,902 homeless persons with a self-reported or laboratory-confirmed HIV status and 1,880 homeless persons with only a laboratory-confirmed HIV status, both cohorts having a HIV prevalence of 4%.After fitting adjusted logistic regression models, the odds of having a self-reported or laboratory-confirmed HIV positive status was 2.03 times higher among males versus females (95% CI: 1.19-3.47, P=0.010) and 2.90 times among those with a history of substance abuse compared to those without (95% CI: 1.59-5.28, P=0.001). A significant interaction between agency conducting screenings and race was identified where the odds of being HIV positive was 1.92 times higher among blacks screened by FCBOH compared to Mercy Care Atlanta (95% CI: 1.10-3.38, P = 0.023). Moreover, the odds of having laboratory-confirmed HIV positive status was 2.13 times higher among males versus females (95% CI: 1.17-3.88, P= 0.014) and 3.66 times higher among those aged 18-37 years versus >51 (95% CI: 1.86-7.20, P < 0.0001).  Those screened in the field were 40% less likely to be HIV positive compared to those screened at the clinic (aOR: 0.60, 95% CI: 0.37-0.97, P= 0.039). This study shows that HIV related health programs should be targeted towards homeless persons who are male at birth, younger, and have a history of substance abuse. FCBOH should continue to improve its HIV screening efforts at the clinic and implement additional programs to improve substance abuse disorders. Future research with a larger population of homeless persons with laboratory-confirmed HIV statuses, more complete information on associated factors, and a focus on unsheltered homeless persons will provide FCBOH with a more complete understanding of HIV prevalence and risk factors among its homeless population.

Table of Contents

 

TABLE OF CONTENTS

 

Title                                                                                                                                       Page

 

Chapter I: Background/Literature Review……………………………….........................……..1

Chapter II: Manuscript……………………………………………………………………………..............10                       

Title, Authors, Abstract………………...............…...……….…………….....................….10

Introduction…………………………………………………………….......................………………11

Methods………………………………………………………………………………….......................13

Study design and ethics, study population and data collection.….............13

Data analysis………………………………………………………..................….…............14

Results…..........................……………………………………………………………………………...16

Cohort description……..............………………………………………………………........16

Bivariate unadjusted analysis and interaction assessment…………..…........17

Multivariate adjusted analysis for self-reported or

laboratory-confirmed HIV positive status (Outcome 1)..….……………….......18

Multivariate adjusted analysis for a laboratory-confirmed

HIV positive status (Outcome 2)……………………….........……………………….......19

Discussion…….......................…………………………………………………………………………..19

References…………………………......................……………………………………………………..25

Tables……………………………………………………….........................…………………………....30

 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Mot-clé	HIV, homeless, risk factors, USA
Committee Chair / Thesis Advisor	Wall, Kristin, Emory University
Partnering Agencies	Georgia state or local health department

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