Racial/Ethnic Disparities in Failure to Initiate HIV Care: Role of HIV Testing Site, Individual Factors, and Neighborhood Factors, Florida, 2014-2015

J Health Care Poor Underserved. 2018;29(3):1153-1175. doi: 10.1353/hpu.2018.0085.

Abstract

Delayed initiation of human immunodeficiency virus (HIV) care affects disease progression. To determine the role of HIV testing site and neighborhood- and individual-level factors in racial/ethnic disparities in initiation of care, we examined Florida population-based HIV/AIDS surveillance system records. We performed multilevel Poisson regression to calculate adjusted prevalence ratios (APR) for non-initiation of care by race/ethnicity adjusting for HIV testing site type and individual- and neighborhood-level characteristics. Of 8,913 people diagnosed with HIV during 2014-2015 in the final dataset, 18.3% were not in care within three months of diagnosis. The APR for non-initiation of care for non-Hispanic Blacks relative to non-Hispanic Whites was 1.57 (95% confidence interval [CI] 1.38-1.78) and for those tested in plasma/donation centers relative to outpatient clinics was 2.45 (95% CI 2.19-2.74). Testing site and individual variables contribute to racial/ethnic disparities in non-initiation of HIV care. Linkage procedures, particularly at plasma/blood donation centers, warrant improvement.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Black or African American / psychology*
  • Black or African American / statistics & numerical data
  • Female
  • Florida
  • HIV Infections / ethnology*
  • HIV Infections / therapy
  • Healthcare Disparities / ethnology*
  • Hispanic or Latino / psychology*
  • Hispanic or Latino / statistics & numerical data
  • Humans
  • Individuality
  • Male
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Patient Acceptance of Health Care / ethnology*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Residence Characteristics / statistics & numerical data
  • Socioeconomic Factors
  • White People / psychology*
  • White People / statistics & numerical data
  • Young Adult