242977 Evaluating the impact of neighborhood-level poverty on racial disparities in HIV outcomes

Monday, October 31, 2011

Victoria Mobley, MD MPH , Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC
Sonia Napravnik , Departments of Medicine and Epidemiology, University of North Carolina, Chapel Hill, NC
Joseph J. Eron, MD , Division of Infectious Diseases, The University of North Carolina at Chapel HIll, Chapel Hill, NC
Adaora Adimora, MD, MPH , Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC
Background: Racial disparities in HIV outcomes persist despite the advent of highly active anti-retroviral therapy (HAART). Because poverty and resource distribution may play a role in racial health disparities, we examined the relationship between neighborhood-level poverty, virologic failure, and race. Methods: We evaluated patients in the Center for AIDS Research Clinical Cohort initiating HAART between 2000-2009. We dichotomized neighborhood poverty (the exposure variable) as US census tracts with < or ≥ 15% of residents living below the poverty line; multivariable logistic regression (adjusted for age, gender and initial viral load) assessed the impact of neighborhood poverty on the relationship between race and virologic failure (viral load>400 copies/mL, 12-18 months after HAART initiation). Results: Of 490 patients (37.3% white; 62.7% black), 24.7% experienced virologic failure (28.1% white; 71.9% black). A greater proportion of blacks than whites (16% vs. 12%; p<0.001) lived in neighborhoods with ≥15% poverty. In neighborhoods with <15% poverty, blacks were more likely to fail than whites (OR 3.21, 95% CI 1.60-6.47); blacks and whites failed at similar rates in neighborhoods with ≥15% poverty (OR 0.75, 95% CI 0.40-1.43). Blacks residing in neighborhoods with <15% poverty were as likely to experience virologic failure as blacks residing in higher poverty neighborhoods (OR 0.81, 95% CI 0.49-1.34). Conclusions: Blacks were more likely than whites to experience virologic failure in wealthier neighborhoods but were as likely to fail as blacks in poorer neighborhoods. Further studies should determine why improved HIV outcomes were not seen in blacks residing in neighborhoods with less poverty.

Learning Areas:
Clinical medicine applied in public health
Diversity and culture

Learning Objectives:
Identify racial disparities in HIV/AIDS health outcomes. Demonstrate how contextual factors affect the relationship between race and HIV/AIDS health outcomes.

Keywords: HIV/AIDS, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I am currently a sub-specialty fellow in the department of Infectious Diseases, with a research focus on racial disparities in HIV/AIDS outcomes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.