P334 Role of neighborhood factors on racial/ethnic differences in sustained HIV viral suppression among Ryan White Program clients in Miami, 2017

Background Neighborhoods characterized by adverse socioeconomic factors may be associated with poor HIV care outcomes, including viral suppression, which varies by race/ethnicity. Health disparities are observed among racial/ethnic minorities in disadvantaged neighborhoods. Moreover, once a person is virally suppressed, it is imperative that suppression is sustained long-term to reduce risk of secondary transmission and disease progression to AIDS. Therefore, the study’s objective was to examine the effect of neighborhood factors on the association between race/ethnicity and sustained viral suppression. Methods A cross-sectional study was conducted using 6,491 people with HIV from the Miami-Dade County Ryan White Program dataset, in 2017. Neighborhood level data was collected from the American Community Survey. Indices were created using exploratory and confirmatory factor analysis for psychosocial and neighborhood level data. Multilevel mixed effects modeling was used to examine the effects of neighborhood characteristics on the association between race/ethnicity and sustained viral suppression ( Results Three neighborhood indices were created (socioeconomic disadvantage index, residential instability index, racial/language homogeneity index), and were categorized into tertiles (low, moderate, high). Significant differences in race/ethnicity was observed within each neighborhood tertiles. Non-Hispanic Blacks had lower odds of sustained viral suppression in neighborhoods characterized by low socioeconomic disadvantage (adjusted odds ratio [aOR]: 0.39; 95% confidence interval [CI]: 0.20–0.74), moderate residential instability (aOR: 0.31; 95% CI: 0.15–0.65), and low racial/language homogeneity (aOR: 0.38; 95% CI: 0.16–0.88) and high (aOR: 0.38; 95% CI: 0.19–0.75), when compared to non-Hispanic Whites. Haitians also exhibited poor outcomes in moderate residential instability (aOR: 0.42; 95% CI: 0.18–0.97) and high racial/language homogeneity neighborhoods (aOR: 0.49; 95% CI: 0.26–0.93), when compared to non-Hispanic Whites. Conclusions Racial/ethnic differences in rates of sustained viral suppression exist in different neighborhood characteristics. Findings indicate that neighborhood factors might affect optimal care for minorities.