Changes in Racial Disparities in Viral Suppression Among People with HIV from 2013–2020: A Statewide Cohort Study

OBJECTIVE: Limited studies have sought to qualify the extent and trends of racial disparities in viral suppression (VS) among people with HIV(PWH) across the Southern US. This study aims to examine the spatiotemporal trend and structural social determinants of racial disparities of VS. METHODS: A population-based retrospective cohort study across all counties in South Carolina (SC) from 2013 to 2020. Linear trend test was employed to explore the temporal trend of the disparity indices (Black to White Ratio [BWR], Index of Disparity [ID], Weighted Index of Disparity [Weighted ID], and Gini coefficient). Linear mixed-effect models were further used to assess the association between different contextual factors and these indices. RESULTS: A decrease in racial disparity in VS (p < 0.01) was observed from 2013 to 2020 across all disparity indices. When measured using Weighted ID and Gini coefficient, lower risk of racial disparities in VS was associated with more Ryan White HIV centers (β = -0.92 and β = -0.0046, respectively) and higher disability rates (β = -1.10 and β = -0.0055, respectively). When measured using ID, Weighted ID, and Gini coefficient, counties in PEE DEE region showed less racial disparities in VS (β = -3.89, -1.73, and -0.0086, respectively, p < 0.05) compared with those in Lowcountry region. CONCLUSIONS: Although a notable decrease in racial disparities in VS was observed among PWH in SC, attention to addressing related social and structural factors (e.g., fewer Ryan White HIV centers within geographic accessibility) that contribute to poorer HIV outcomes is still needed.