Longitudinal Patterns and Predictors of Racial Disparities of HIV Retention in Care: A Statewide Cohort Analysis

Racial disparities have historically existed regarding HIV care outcomes, including retention in care (RIC). However, data regarding the longitudinal patterns and predictors of such disparities among different racial groups and various geolocations are limited. This study aims to explore the contribution of contextual features (e.g., socioeconomic and structural environmental factors) to the changes in RIC outcome disparity at the county level. All adult people with HIV who received a HIV diagnosis in South Carolina (SC) between 2013 and 2020 were included in this study, and their de-identified CD4 counts and viral load information were derived from the SC statewide HIV registry system. All contextual factors were extracted from multiple publicly available datasets, such as the American Community Survey. To provide a comprehensive view, we used four indices to measure racial disparities in the county-level percentage of RIC, i.e., Black to White ratio (BWR), Index of Disparity (ID), Weighted Index of Disparity (Weighted ID), and Gini coefficient. Linear mixed-effect models were used to estimate the relationship between various contextual factors and these disparity indexes, except BWR. The temporal trend of the four indices suggested no significant increase or decrease in racial disparities in RIC across 46 counties in SC from 2013 to 2020. Counties with more primary care providers and higher social capital in collective efficacy showed lower racial disparities in RIC when ID and Gini coefficient were used as outcomes. For ID only, higher racial disparities in RIC were observed in counties with lower isolation index (β=-1.92, 95%CI: -3.31~-0.53). For weighted ID only, no county-level contextual features explored were significantly associated with racial disparities in RIC. Racial disparities in RIC persist without major changes in SC despite the national implementation of the "Ending the HIV Epidemic" initiative. Efforts to address racial disparities should continue; specifically, efforts that focus on social and structural factors should be developed and implemented for populations that have poor HIV outcomes in the US.