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Exploring the Spatial Determinants of Late HIV Diagnosis in Texas.

ABSTRACT: INTRODUCTION:Despite statewide progress and continuous HIV prevention efforts in Texas, HIV diagnosis at a late stage of infection persists. Diagnosis delay differs in magnitude and spatial distribution. We examined the local spatial relationships of late HIV diagnosis with a selection of variables in an area of Texas that includes large metropolises and high HIV morbidity. METHODS:We compared regression modeling approaches to study the associations between the regional percentage of late HIV diagnosis from 2011 through 2015, regional measures of poverty, lack of health insurance (uninsurance), educational attainment, unemployment, and the average regional distance from residence to an HIV testing site: global ordinary least squares linear regression, spatial error model, geographically weighted regression, and multiscale geographically weighted regression (MGWR). Cartographic representation of the local R2, coefficient estimates, and their t values assisted in the interpretation of results. RESULTS:The MGWR model resulted in a better fit and identified education and uninsurance as globally fixed predictors, whereas the relationships between late HIV diagnosis and poverty, unemployment, and distance varied spatially. The model performed better in rural areas and in suburban areas of the largest cities than in urban areas. CONCLUSION:The MGWR results provided local estimates of associations. The results highlight the importance of focusing on a local context. Modeling at the local scale is particularly useful for characterizing relationships between explanatory and dependent variables when the relationships vary spatially. In the context of HIV prevention, relationships that are of local relevance can inform local policy and complement routine screening in clinical settings.

SUBMITTER: Arbona SI

PROVIDER: S-EPMC7478160 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Exploring the Spatial Determinants of Late HIV Diagnosis in Texas.

Arbona Sonia I SI Barro Alassane S AS

Preventing chronic disease 20200827

<h4>Introduction</h4>Despite statewide progress and continuous HIV prevention efforts in Texas, HIV diagnosis at a late stage of infection persists. Diagnosis delay differs in magnitude and spatial distribution. We examined the local spatial relationships of late HIV diagnosis with a selection of variables in an area of Texas that includes large metropolises and high HIV morbidity.<h4>Methods</h4>We compared regression modeling approaches to study the associations between the regional percentage ...[more]

PMID: 32857031

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Project description:BackgroundThe aim of our work was to evaluate the potential impact of the European policy of testing for HIV all individuals presenting with an indicator disease, to prevent late diagnosis of HIV. We report on a retrospective analysis among individuals diagnosed with HIV to assess whether a history of certain diseases prior to HIV diagnosis was associated with the chance of presenting late for care, and to estimate the proportion of individuals presenting late who could have been diagnosed earlier if tested when the indicator disease was diagnosed.MethodsWe studied a large cohort of individuals newly diagnosed with HIV infection in 13 counselling and testing sites in the Lazio Region, Italy (01/01/2004-30/04/2009). Considered indicator diseases were: viral hepatitis infection (HBV/HCV), sexually transmitted infections, seborrhoeic dermatitis and tuberculosis. Logistic regression analysis was performed to estimate association of occurrence of at least one indicator disease with late HIV diagnosis.ResultsIn our analysis, the prevalence of late HIV diagnosis was 51.3% (890/1735). Individuals reporting at least one indicator disease before HIV diagnosis (29% of the study population) had a lower risk of late diagnosis (OR?=?0.7; 95%CI: 0.5-0.8) compared to those who did not report a previous indicator disease. 52/890 (5.8%) late presenters were probably already infected at the time the indicator disease was diagnosed, a median of 22.6 months before HIV diagnosis.ConclusionsOur data suggest that testing for HIV following diagnosis of an indicator disease significantly decreases the probability of late HIV diagnosis. Moreover, for 5.5% of late HIV presenters, diagnosis could have been anticipated if they had been tested when an HIV indicator disease was diagnosed.However, this strategy for enhancing early HIV diagnosis needs to be complemented by client-centred interventions that aim to increase awareness in people who do not perceive themselves as being at risk for HIV.

Project description:BackgroundGastric cancer disproportionately affects Latinos, but little is known about regional effects and risk factors. We compared primary incidence, late-stage diagnosis, and risk factors for gastric adenocarcinoma (GCA) from 2004 to 2016 in Latinos and non-Latinos in the United States, Texas (TX), and South Texas (STX).MethodsWe collected case data from Surveillance, Epidemiology, and End Results (SEER) and the Texas Cancer Registry. We generated average annual age-adjusted incidence rates, rate ratios (RRs), and 95% confidence intervals (CIs) using SEER*Stat software and analyzed the cases by anatomic site, demographics, and county-level risk factors using SAS 9.4. We constructed multilevel logistic regression models for late-stage GCA, adjusting for patient- and county-level characteristics.ResultsLatinos had higher overall GCA incidence rates in all regions, with the greatest disparities in overlap GCA in STX males (RR 4.39; 95% CI: 2.85, 6.93). There were no differences in cardia GCA rates for non-Hispanic Whites (NHWs) and Latino women in all regions. Younger patients, patients with overlapping or not otherwise specified (NOS) lesions, and patients diagnosed during 2012-2016 had higher odds of late-stage GCA. The stratification by location showed no differences in late-stage disease between NHWs and Latinos. The stratification by anatomic site showed Latinos with cardia GCA were more likely to have late-stage GCA than NHWs (OR: 1.13, p = 0.008). At the county level, higher odds of late-stage GCA were associated with medium and high social deprivation levels in TX without STX (OR: 1.25 and 1.20, p = 0.007 and 0.028, respectively), and medium social deprivation index (SDI) in patients with NOS GCA (OR: 1.21, p = 0.01).ConclusionsSTX Latinos experience greater GCA disparities than those in TX and the United States. Younger age and social deprivation increase the risk for late-stage GCA, while Latinos and women are at higher risk specifically for late-stage cardia GCA. There is a need for population-specific, culturally responsive intervention and prevention measures, and additional research to elucidate contributing risk factors.

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Exploring the Spatial Determinants of Late HIV Diagnosis in Texas.

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Exploring the Spatial Determinants of Late HIV Diagnosis in Texas.

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