Date of Award

Fall 12-14-2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Dr. Sheryl Strasser

Second Advisor

Dr. Dajun Dai

Third Advisor

Dr. Scott Masten

Abstract

Advances in HIV care and treatment continue to prolong the lives of people diagnosed and living with HIV (PDLWH). The National HIV/AIDS Strategy mobilizes national, state, and local efforts toward ensuring equitable access to care, reducing disparities, and improving continuum of HIV care outcomes. A social/community-based factor that contributes to sub-optimal HIV outcomes for PDLWH – all of whom require regular visits to a medical facility – is access to accommodating, affordable, and acceptable HIV care providers. Employing case surveillance data to analyze relationships between social/community-based factors and HIV disease outcomes is an opportunity to identify underserved PDLWH. This analytic approach, linking individual case-level epidemiologic surveillance data with macro-level community measures, provides public health departments a more precise estimate of priority geographic zones and subpopulation clusters whereby limited public health resources can be directed for maximal impact and efficiency.

This dissertation analyzed California HIV surveillance system (CHSS) data to characterize PDLWH in terms of residential census tract characteristics related to income, poverty, unemployment, vehicle access, population density, travel duration from residence to care facility, and access to care. The primary study population was 60,979 PDLWH as of 2014 who had recent, geocoded residential addresses collected in CHSS. Access to care was measured using a novel enhanced two-step floating catchment area (E2SFCA) method developed for this dissertation. We also assessed whether community characteristics, trip duration, and access to care were associated with suppressed viral load, an indicator of successful disease management. Several significant relationships were found between suppressed viral load and where people lived, how long they drove for care, and their E2SFCA-measured access to care. This analysis identifies new methods for state and local health jurisdictions to: investigate factors associated with HIV-specific health disparities, improve the capacity to direct resources for improving health outcomes for PDLWH, and enhance transmission prevention efforts.

DOI

https://doi.org/10.57709/9473115

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