The Contribution of Socioeconomic Factors to HIV RNA Suppression in Persons with HIV Engaged in Care in the NA-ACCORD

Abstract

Socioeconomic status (SES) influences well-being among people living with HIV (PWH); when individual-level SES information is not available, area-level SES indicators may be a suitable alternative. We hypothesized that: a) select ZIP Code-level SES indicators would be associated with viral suppression, and b) accounting for ZIP Code-level SES would attenuate racial disparities in viral suppression among PWH. The NA-ACCORD, a collaboration of clinical and interval cohorts of PWH. Participants with ≥1 viral load measurement and ≥1 US residential 5-digit ZIP Code(s) between 2010-2018 were included. In this serial cross-sectional analysis, multivariable logistic regression models were used to quantify the annual association of race and ethnicity with viral suppression, in the presence of SES indicators as well as sex, Hepatitis C status, and age. We observed a dose response relationship between SES factors and viral suppression. Lower income and education were associated with 0.5 to 0.7-fold annual decreases in odds of viral suppression. We observed racial disparities of ∼40% decreased odds of viral suppression among non-Hispanic Black compared with non-Hispanic White individuals. The disparity persisted but narrowed by 3-4% when including SES in the models. ZIP Code-based SES was associated with viral suppression, and accounting for SES narrowed racial disparities in viral suppression among PWH in the NA-ACCORD. Inclusion of ZIP Code-level indicators of SES as surrogates for individual-level SES should be considered to improve our understanding of the impact of social determinants of health and racial disparities on key outcomes among PWH in North America.