Structural Determinants of Antiretroviral Therapy Use, HIV Care Attendance, and Viral Suppression among Adolescents and Young Adults Living with HIV
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{"title"=>"Structural determinants of antiretroviral therapy use, HIV care attendance, and viral suppression among adolescents and young adults living with HIV", "type"=>"journal", "authors"=>[{"first_name"=>"Shoshana Y.", "last_name"=>"Kahana", "scopus_author_id"=>"6603931966"}, {"first_name"=>"Richard A.", "last_name"=>"Jenkins", "scopus_author_id"=>"7402399975"}, {"first_name"=>"Douglas", "last_name"=>"Bruce", "scopus_author_id"=>"36897440600"}, {"first_name"=>"Maria I.", "last_name"=>"Fernandez", "scopus_author_id"=>"57092950900"}, {"first_name"=>"Lisa B.", "last_name"=>"Hightow-Weidman", "scopus_author_id"=>"23094096600"}, {"first_name"=>"Jose A.", "last_name"=>"Bauermeister", "scopus_author_id"=>"57195541085"}], "year"=>2016, "source"=>"PLoS ONE", "identifiers"=>{"pmid"=>"27035905", "doi"=>"10.1371/journal.pone.0151106", "sgr"=>"84963642838", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "scopus"=>"2-s2.0-84963642838", "issn"=>"19326203", "pui"=>"609632953"}, "id"=>"3827cedb-3934-3fd7-a70d-6949805e7c8c", "abstract"=>"BACKGROUND The authors examined associations between structural characteristics and HIV disease management among a geographically diverse sample of behaviorally and perinatally HIV-infected adolescents and young adults in the United States. METHODS The sample included 1891 adolescents and young adults living with HIV (27.8% perinatally infected; 72.2% behaviorally infected) who were linked to care through 20 Adolescent Medicine Trials Network for HIV/AIDS Interventions Units. All completed audio computer-assisted self-interview surveys. Chart abstraction or blood draw provided viral load data. Geographic-level variables were extracted from the United States Census Bureau (e.g., socioeconomic disadvantage, percent of Black and Latino households, percent rural) and Esri Crime (e.g., global crime index) databases as Zip Code Tabulation Areas. AIDSVu data (e.g., prevalence of HIV among youth) were extracted at the county-level. Using HLM v.7, the authors conducted means-as-outcomes random effects multi-level models to examine the association between structural-level and individual-level factors and (1) being on antiretroviral therapy (ART) currently; (2) being on ART for at least 6 months; (3) missed HIV care appointments (not having missed any vs. having missed one or more appointments) over the past 12 months; and (4) viral suppression (defined by the corresponding assay cutoff for the lower limit of viral load at each participating site which denoted nondetectability vs. detectability). RESULTS Frequencies for the 4 primary outcomes were as follows: current ART use (n = 1120, 59.23%); ART use for ≥6 months (n = 861, 45.53%); at least one missed HIV care appointment (n = 936, 49.50); and viral suppression (n = 577, 30.51%). After adjusting for individual-level factors, youth living in more disadvantaged areas (defined by a composite score derived from 2010 Census indicators including percent poverty, percent receiving public assistance, percent of female, single-headed households, percent unemployment, and percent of people with less than a high school degree) were less likely to report current ART use (OR: 0.85, 95% CI: 0.72-1.00, p = .05). Among current ART users, living in more disadvantaged areas was associated with greater likelihood of having used ART for ≥6 months. Participants living in counties with greater HIV prevalence among 13-24 year olds were more likely to report current ART use (OR: 1.32, 95% CI: 1.05-1.65, p = .02), ≥6 months ART use (OR: 1.32, 95% CI: 1.05-1.65, p = .02), and to be virally suppressed (OR: 1.50, 95% CI: 1.20-1.87, p = .001); however, youth in these areas were also more likely to report missed medical appointments (OR: 1.32, 95% CI: 1.07-1.63, p = .008). CONCLUSIONS The findings underscore the multi-level and structural factors associated with ART use, missed HIV care appointments, and viral suppression for adolescents and young adults in the United States. Consideration of these factors is strongly recommended in future intervention, clinical practice, and policy research that seek to understand the contextual influences on individuals' health behaviors.", "link"=>"http://www.mendeley.com/research/structural-determinants-antiretroviral-therapy-hiv-care-attendance-viral-suppression-among-adolescen", "reader_count"=>42, "reader_count_by_academic_status"=>{"Unspecified"=>5, "Librarian"=>1, "Student > Doctoral Student"=>5, "Researcher"=>7, "Student > Ph. D. Student"=>8, "Student > Master"=>13, "Other"=>2, "Student > Bachelor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>5, "Librarian"=>1, "Student > Doctoral Student"=>5, "Researcher"=>7, "Student > Ph. D. 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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/4903423"], "description"=>"<p>Structural-Level Correlates of Current ART Use, ≥6 Months ART Use, and Missed HIV Care Appointments.</p>", "links"=>[], "tags"=>["United States Census Bureau", "2010 Census indicators", "factor", "Zip Code Tabulation Areas", "HIV Care Attendance", "HLM", "HIV care appointments", "United States.MethodsThe sample", "20 Adolescent Medicine Trials Network", "HIV BackgroundThe authors", "Young Adults Living", "HIV care appointment", "HIV disease management", "ART use", "percent", "CI"], "article_id"=>3147040, "categories"=>["Medicine", "Biotechnology", "Biological Sciences not elsewhere classified", "Cancer", "Science Policy", "Infectious Diseases", "Virology"], "users"=>["Shoshana Y. Kahana", "Richard A. Jenkins", "Douglas Bruce", "Maria I. Fernandez", "Lisa B. Hightow-Weidman", "Jose A. Bauermeister"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0151106.t003", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Structural_Level_Correlates_of_Current_ART_Use_6_Months_ART_Use_and_Missed_HIV_Care_Appointments_/3147040", "title"=>"Structural-Level Correlates of Current ART Use, ≥6 Months ART Use, and Missed HIV Care Appointments.", "pos_in_sequence"=>4, "defined_type"=>3, "published_date"=>"2016-04-01 06:53:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/4903408"], "description"=>"<div><p>Background</p><p>The authors examined associations between structural characteristics and HIV disease management among a geographically diverse sample of behaviorally and perinatally HIV-infected adolescents and young adults in the United States.</p><p>Methods</p><p>The sample included 1891 adolescents and young adults living with HIV (27.8% perinatally infected; 72.2% behaviorally infected) who were linked to care through 20 Adolescent Medicine Trials Network for HIV/AIDS Interventions Units. All completed audio computer–assisted self-interview surveys. Chart abstraction or blood draw provided viral load data. Geographic-level variables were extracted from the United States Census Bureau (e.g., socioeconomic disadvantage, percent of Black and Latino households, percent rural) and Esri Crime (e.g., global crime index) databases as Zip Code Tabulation Areas. AIDSVu data (e.g., prevalence of HIV among youth) were extracted at the county-level. Using HLM v.7, the authors conducted means-as-outcomes random effects multi-level models to examine the association between structural-level and individual-level factors and (1) being on antiretroviral therapy (ART) currently; (2) being on ART for at least 6 months; (3) missed HIV care appointments (not having missed any vs. having missed one or more appointments) over the past 12 months; and (4) viral suppression (defined by the corresponding assay cutoff for the lower limit of viral load at each participating site which denoted nondetectability vs. detectability).</p><p>Results</p><p>Frequencies for the 4 primary outcomes were as follows: current ART use (n = 1120, 59.23%); ART use for ≥6 months (n = 861, 45.53%); at least one missed HIV care appointment (n = 936, 49.50); and viral suppression (n = 577, 30.51%). After adjusting for individual-level factors, youth living in more disadvantaged areas (defined by a composite score derived from 2010 Census indicators including percent poverty, percent receiving public assistance, percent of female, single-headed households, percent unemployment, and percent of people with less than a high school degree) were less likely to report current ART use (OR: 0.85, 95% CI: 0.72–1.00, p = .05). Among current ART users, living in more disadvantaged areas was associated with greater likelihood of having used ART for ≥6 months. Participants living in counties with greater HIV prevalence among 13–24 year olds were more likely to report current ART use (OR: 1.32, 95% CI: 1.05–1.65, p = .02), ≥6 months ART use (OR: 1.32, 95% CI: 1.05–1.65, p = .02), and to be virally suppressed (OR: 1.50, 95% CI: 1.20–1.87, p = .001); however, youth in these areas were also more likely to report missed medical appointments (OR: 1.32, 95% CI: 1.07–1.63, p = .008).</p><p>Conclusions</p><p>The findings underscore the multi-level and structural factors associated with ART use, missed HIV care appointments, and viral suppression for adolescents and young adults in the United States. Consideration of these factors is strongly recommended in future intervention, clinical practice, and policy research that seek to understand the contextual influences on individuals’ health behaviors.</p></div>", "links"=>[], "tags"=>["United States Census Bureau", "2010 Census indicators", "factor", "Zip Code Tabulation Areas", "HIV Care Attendance", "HLM", "HIV care appointments", "United States.MethodsThe sample", "20 Adolescent Medicine Trials Network", "HIV BackgroundThe authors", "Young Adults Living", "HIV care appointment", "HIV disease management", "ART use", "percent", "CI"], "article_id"=>3147025, "categories"=>["Medicine", "Biotechnology", "Biological Sciences not elsewhere classified", "Cancer", "Science Policy", "Infectious Diseases", "Virology"], "users"=>["Shoshana Y. Kahana", "Richard A. Jenkins", "Douglas Bruce", "Maria I. Fernandez", "Lisa B. Hightow-Weidman", "Jose A. Bauermeister"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0151106", "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Structural_Determinants_of_Antiretroviral_Therapy_Use_HIV_Care_Attendance_and_Viral_Suppression_among_Adolescents_and_Young_Adults_Living_with_HIV/3147025", "title"=>"Structural Determinants of Antiretroviral Therapy Use, HIV Care Attendance, and Viral Suppression among Adolescents and Young Adults Living with HIV", "pos_in_sequence"=>1, "defined_type"=>6, "published_date"=>"2016-04-01 06:53:57"}
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  • {"files"=>["https://ndownloader.figshare.com/files/4903429"], "description"=>"<p>Multi-level Associations between Viral Load Suppression and Structural- and Individual- Level Characteristics.</p>", "links"=>[], "tags"=>["United States Census Bureau", "2010 Census indicators", "factor", "Zip Code Tabulation Areas", "HIV Care Attendance", "HLM", "HIV care appointments", "United States.MethodsThe sample", "20 Adolescent Medicine Trials Network", "HIV BackgroundThe authors", "Young Adults Living", "HIV care appointment", "HIV disease management", "ART use", "percent", "CI"], "article_id"=>3147046, "categories"=>["Medicine", "Biotechnology", "Biological Sciences not elsewhere classified", "Cancer", "Science Policy", "Infectious Diseases", "Virology"], "users"=>["Shoshana Y. Kahana", "Richard A. Jenkins", "Douglas Bruce", "Maria I. Fernandez", "Lisa B. Hightow-Weidman", "Jose A. Bauermeister"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0151106.t005", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Multi_level_Associations_between_Viral_Load_Suppression_and_Structural_and_Individual_Level_Characteristics_/3147046", "title"=>"Multi-level Associations between Viral Load Suppression and Structural- and Individual- Level Characteristics.", "pos_in_sequence"=>6, "defined_type"=>3, "published_date"=>"2016-04-01 06:53:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/4903414"], "description"=>"<p>Demographic, Biomedical, and Psychosocial/Behavioral Characteristics of Perinatally and Behaviorally HIV-Infected Adolescents and Young Adults Linked to Care (n = 1891).</p>", "links"=>[], "tags"=>["United States Census Bureau", "2010 Census indicators", "factor", "Zip Code Tabulation Areas", "HIV Care Attendance", "HLM", "HIV care appointments", "United States.MethodsThe sample", "20 Adolescent Medicine Trials Network", "HIV BackgroundThe authors", "Young Adults Living", "HIV care appointment", "HIV disease management", "ART use", "percent", "CI"], "article_id"=>3147031, "categories"=>["Medicine", "Biotechnology", "Biological Sciences not elsewhere classified", "Cancer", "Science Policy", "Infectious Diseases", "Virology"], "users"=>["Shoshana Y. Kahana", "Richard A. Jenkins", "Douglas Bruce", "Maria I. Fernandez", "Lisa B. Hightow-Weidman", "Jose A. Bauermeister"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0151106.t001", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Demographic_Biomedical_and_Psychosocial_Behavioral_Characteristics_of_Perinatally_and_Behaviorally_HIV_Infected_Adolescents_and_Young_Adults_Linked_to_Care_n_1891_/3147031", "title"=>"Demographic, Biomedical, and Psychosocial/Behavioral Characteristics of Perinatally and Behaviorally HIV-Infected Adolescents and Young Adults Linked to Care (n = 1891).", "pos_in_sequence"=>2, "defined_type"=>3, "published_date"=>"2016-04-01 06:53:57"}
  • {"files"=>["https://ndownloader.figshare.com/files/4903420"], "description"=>"<p>Description of ZCTA- and County-Level Derived Structural-Level Characteristics.</p>", "links"=>[], "tags"=>["United States Census Bureau", "2010 Census indicators", "factor", "Zip Code Tabulation Areas", "HIV Care Attendance", "HLM", "HIV care appointments", "United States.MethodsThe sample", "20 Adolescent Medicine Trials Network", "HIV BackgroundThe authors", "Young Adults Living", "HIV care appointment", "HIV disease management", "ART use", "percent", "CI"], "article_id"=>3147037, "categories"=>["Medicine", "Biotechnology", "Biological Sciences not elsewhere classified", "Cancer", "Science Policy", "Infectious Diseases", "Virology"], "users"=>["Shoshana Y. Kahana", "Richard A. Jenkins", "Douglas Bruce", "Maria I. Fernandez", "Lisa B. Hightow-Weidman", "Jose A. Bauermeister"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0151106.t002", "stats"=>{"downloads"=>0, "page_views"=>1, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Description_of_ZCTA_and_County_Level_Derived_Structural_Level_Characteristics_/3147037", "title"=>"Description of ZCTA- and County-Level Derived Structural-Level Characteristics.", "pos_in_sequence"=>3, "defined_type"=>3, "published_date"=>"2016-04-01 06:53:57"}

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Relative Metric

{"start_date"=>"2016-01-01T00:00:00Z", "end_date"=>"2016-12-31T00:00:00Z", "subject_areas"=>[]}
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