County-level variations in linkage to care among people newly diagnosed with HIV in South Carolina: A longitudinal analysis from 2010 to 2018

• Published in: PloS one 2023-05, Vol.18 (5), p.e0286497-e0286497
• Main Authors: Shi, Fanghui, Zhang, Jiajia, Zeng, Chengbo, Sun, Xiaowen, Li, Zhenlong, Yang, Xueying, Weissman, Sharon, Olatosi, Bankole, Li, Xiaoming
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Biology and Life Sciences; Care and treatment; Continuity of Patient Care; Disease control; Education; Engineering and Technology; Evaluation; Geographical variations; Health care access; Health care facilities; Health facilities; HIV; HIV (Viruses); HIV Infections - diagnosis; HIV Infections - epidemiology; HIV Infections - therapy; Human immunodeficiency virus; Humans; Infection control; Male; Mass Screening; Medical diagnosis; Medical laboratories; Medicine and health sciences; Mental health; Patient outcomes; People and places; Population; Primary care; Race; Religion; Segregation; Social capital; Social Sciences; Sociodemographics; Socioeconomic factors; South Carolina - epidemiology; Statistical data; Surveillance; United States; Variables
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0286497

Timely linkage to care (LTC) is key in the HIV care continuum, as it enables people newly diagnosed with HIV (PNWH) to benefit from HIV treatment at the earliest stage. Previous studies have found LTC disparities by individual factors, but data are limited beyond the individual level, especially at the county level. This study examined the temporal and geographic variations of county-level LTC status across 46 counties in South Carolina (SC) from 2010 to 2018 and the association of county-level characteristics with LTC status. All adults newly diagnosed with HIV from 2010 to 2018 in SC were included in this study. County-level LTC status was defined as 1 = "high LTC (≥ yearly national LTC percentage)" and 0 = "low LTC (< yearly national LTC percentage)". A generalized estimating equation model with stepwise selection was employed to examine the relationship between 29 county-level characteristics and LTC status. The number of counties with high LTC in SC decreased from 34 to 21 from 2010 to 2018. In the generalized estimating equation model, six out of 29 factors were significantly associated with LTC status. Counties with a higher percentage of males (OR = 0.07, 95%CI: 0.02~0.29) and persons with at least four years of college (OR = 0.07, 95%CI: 0.02~0.34) were less likely to have high LTC. However, counties with more mental health centers per PNWH (OR = 45.09, 95%CI: 6.81~298.55) were more likely to have high LTC. Factors associated with demographic characteristics and healthcare resources contributed to the variations of LTC status at the county level. Interventions targeting increasing the accessibility to mental health facilities could help improve LTC.