DOI
https://doi.org/10.25772/XEDB-MW40
Author ORCID Identifier
65945211
Defense Date
2023
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Healthcare Policy & Research
First Advisor
April Kimmel
Second Advisor
Bassam Dahman
Third Advisor
Alex Krist
Fourth Advisor
Gretchen Neigh
Abstract
This dissertation examines the role of access to primary care in benefitting HIV outcomes through increased access to HIV prevention, care, and treatment services, among populations disproportionately affected by HIV in the US. Over 30,000 individuals are newly diagnosed with HIV annually in the US and diagnoses are concentrated in specific populations. At an individual-level, ~ 70% of new diagnoses are among gay and bisexual men and of those diagnoses, 70% are among Non-Hispanic Black and Hispanic gay and bisexual men. At a community-level, over 50% of new HIV diagnoses occur in less than 2% of US counties (48), Washington, DC, and San Juan, PR, with urban areas in the South disproportionately represented (23). Access to primary care may increase access to HIV services, benefitting HIV outcomes and reducing HIV transmission. However, research examining these relationships is limited. To gain insight into how primary care access may impact access to HIV services and HIV outcomes among individuals and communities most impacted, this dissertation addresses 3 research questions:
1) Are there disparities in access to primary care for Non-Hispanic Black and Hispanic gay and bisexual men, compared to Non-Hispanic White gay and bisexual men?
2) In a sample of urban communities in the US South experiencing high rates of new HIV diagnoses, is the presence (i.e., density) of highly accessible primary care sites, Federally Qualified Health Centers (FQHCs), associated with community-level indicators of HIV epidemic control and is the relationship sensitive to community racial composition?
3) Using the same sample, is FQHC use (i.e., penetration or percent low-income population using any FQHC), associated with community-level indicators of HIV epidemic control?
Our results suggest that individuals at highest risk of HIV, Non-Hispanic Black and Hispanic gay and bisexual men, have lower access to any primary care, compared to Non-Hispanic White gay and bisexual men, which may result in less access to HIV services. Community-level analysis suggests that presence of FQHCs (i.e., density) benefits community late HIV diagnosis (lower), percent linked to care, and percent virally suppressed (both higher). Further, impact may be greatest in communities with fewer primary care or HIV resources and for communities with higher proportions of Black residents. Community FQHC use (i.e., penetration) was associated with greater viral suppression but no relationship to percent late diagnosis or percent linked to care. Further research to identify 1) barriers to primary care access specifically for Non-Hispanic Black and Hispanic gay and bisexual men and 2) barriers to HIV testing and linkage to care at FQHCs would benefit continued forward progress towards ending the HIV epidemic in the US.
Rights
© Jessica S. Kiernan
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
5-11-2023
Included in
Clinical Epidemiology Commons, Community Health and Preventive Medicine Commons, Health Services Research Commons