Disparities in the HIV Care Continuum among Hispanics in the United States

Johns Hopkins University, Baltimore MD

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Abstract

? DESCRIPTION (provided by applicant): The HIV epidemic has disproportionately affected the Hispanic population in the United States (US). Hispanics face the second-highest prevalence and incidence rates of HIV. Hispanics are also more likely to receive HIV care at later stages of HIV disease progression relative to any other racial or ethnic group. A complex set of unique individual- and structural-level factors confront this population and contribute to the burden of health disparities in HIV care and treatment experienced by Hispanics. In 2015, the National HIV/AIDS Strategy for the United States: Updated to 2020 (NHAS) set forth goals to reduce HIV-related disparities in high-risk populations, such as Hispanics, and to increase the proportion of individuals successfully engaged at all levels of the spectrum of HIV care and treatment. This spectrum, termed the HIV care continuum (HIVCC), has become a high-priority area for intervention. Increasing the proportions of HIV-infected individuals who progress through and ultimately reach the last stage of the HIVCC (viral suppression) has been shown to prevent over 90% of new HIV infections. To address the Hispanic population's unique HIV-related needs, it is critical to monitor trends in HIV care indicators for improvement over time and to identify the factors underlying HIV care in this population for the development of tailored public health interventions. We aim to: 1) estimate trends in the proportion of adult Hispanics that were in the last three steps of the HIVCC (retention in HIV care, prescription of antiretrovirl therapy [ART], and viral suppression) from 2004 to 2014; 2) identify demographic factors and behavioral targets for interventions to improve retention in HIV care, ART use, and viral suppression among Hispanic adults in HIV care in the US; and 3) explore the nature of progression through the last three steps of the HIVCC among adult Hispanics and identify the structural-level barriers and facilitators influencing this progression using qualitative research methods. For Aims 1 and 2, we will use data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). The NA-ACCORD offers the largest-available source of longitudinal data on HIV- infected Hispanics (>15,000) in the US and has been endorsed by the Institute of Medicine as an appropriate data source for monitoring progress in NHAS goals. We will conduct qualitative in-depth interviews (N=25) with HIV-infected Hispanics in Baltimore City in Aim 3 to obtain a rich, complementary understanding of structural- level factors influencing HIVCC proportions among Hispanics. The results of this research will inform strategies designed to achieve NHAS goals to reduce health disparities and improve HIV care among Hispanics.