Transcript Home is where the HAART is: An examination of the factors

Home is where the HAART is:
An examination of the factors affecting
neighbourhood perception for people
living with HIV/AIDS
Alexis Palmer
Drug Treatment Program
BC Centre for Excellence in HIV/AIDS
Background
• Food security
• Stable housing
• Gender
Neighbourhood
Perceptions
Social factors
• Employment
• Education
• Problems
• Drug use
• Cohesion
• QoLife Components
• Standard of Living
• CD4
• Viral load suppression
• Depression
• On HAART
HIV health
Health status &
overall well-being
Background
Neighbourhood
Perceptions
Problems
Cohesion
Standard of Living
Background
“In your neighbourhood, how much of a problem are the following?”
• Litter, rubbish, & vandalism
• Assaults, muggings, & burglaries
Neighbourhood
• Reputation of the neighbourhood
Perceptions
• Lack of recreational facilities
Problems
Cohesion
Standard of Living
Background
“Thinking about your neighbors and the other people that live in your
neighbourhood, tell us how you feel about the following statements”
• I believe my neighbors would help in an emergency
• I feel like I belong to this neighbourhood
Neighbourhood
• I agree with people in my neighbourhood about what is important in life
• Perceptions
Living in this neighbourhood gives me a sense of community
Problems
Cohesion
Standard of Living
Background
“Comparing your standard of living to your neighbors,
would you say you are”
• much better off
• a little better off
Neighbourhood
• about the same
Perceptions
• a little worse off
• much worse off
Problems
Cohesion
Standard of Living
Objectives
1.
To identify the factors associated with
neighbourhood perceptions
2.
To assess the role of food security and stable
housing on neighbourhood perceptions
Methods

Longitudinal Investigations into Supportive and Ancillary health
services (LISA) cohort is a prospective study of HIV+ persons on
HAART

Participants recruited from the Drug Treatment Program at the BC
Centre for Excellence in HIV/AIDS

Interview administered survey that collects information




Univariable analyses examined the associations between PROBLEMS
and COHESION and a series of explanatory variables
Univariable analyses used to test association of CD4 count and viral
load with food security and stable housing
Wilcoxon Rank-sum test used for continuous variables and Fisher’s
Exact test used for categorical variables
Multivariable analyses used to explore impact of food security and
stable housing on perceptions of neighbourhood PROBLEMS and
COHESION
Results
LISA Cohort (n=510)
Food Insecure
71%
Unstable Housing
35%
Male
76%
Currently Employed
23%
High school Education or Greater
56%
Illicit Drug Use
 Never Drugs
 Yes, Not Current
 Current
14.5%
37.3%
48.2%
Age (median)
45.7 (40.2-51.8)
Results (2) Social factors
Mean scores
Problems
Cohesion
Food secure
23 vs 41
64 vs 54
Stable housing
29 vs 49
60 vs 51
Male
34 vs 43
58 vs 53
Employed
26 vs 39
61 vs 56
>High school education
34 vs 39
60 vs 54
Current drug user
47 vs 26
54 vs 60
*Bold is statistically significant p < 0.05
Results (3) Social factors
Standard of Living
Percentages
Better
Same
Worse
Food secure
Y
N
39%
26%
48%
47%
13%
27%
Stable housing
Y
N
28%
34%
47%
47%
25%
19%
Male
Y
N
30%
32%
48%
42%
22%
26%
Employed
Y
N
31%
30%
52%
45%
17%
25%
>High school education
Y
N
29%
31%
50%
43%
21%
26%
Current drug user
Y
N
32%
28%
47%
47%
21%
25%
*Bold is statistically significant p < 0.05
Results (4) HIV health
Mean scores
Problems
Cohesion
CD4 > 200
33 vs 43
58 vs 56
Suppressed viral load
33 vs 41
58 vs 55
Depression
42 vs 28
54 vs 61
On HAART
35 vs 43
57 vs 56
*Bold is statistically significant p < 0.05
Results (5) HIV health
Percentages
Standard of Living
Better
Same
Worse
CD4 > 200
30%
29%
48%
43%
22%
28%
Suppressed viral load
31%
28%
48%
48%
21%
24%
Depression
27%
34%
45%
50%
28%
16%
On HAART
31%
25%
47%
45%
22%
30%
*Bold is statistically significant p < 0.05
Results (6) Multivariable confounder model
Association between Problems/Cohesion and Food/Housing security,
accounting for other variables
Coefficient
Problems
Cohesion
-7.3
6.6
-13.1
5.6
-6.7
5.1
Not included in final model
-3.7
2.4
3.5
13.1
.90
CD4 > 200
Not included in final model
Not included in final model
Suppressed viral load
Not included in final model
Not included in final model
Depression
5.9
Not included in final model
On HAART
Not included in final model
Not included in final model
Food secure
Stable housing
Male
Employed
>High school education
Current drug user
*Bold is statistically significant p < 0.05
Results (7) Multivariable confounder model
Association between Problems/Cohesion and Food/Housing security,
accounting for other variables
Coefficient
Problems
Cohesion
Life satisfaction
Not included in final model
2.3
Health worries
Not included in final model
-0.76
-0.03
0.39
HIV mastery
Not included in final model
Not included in final model
Disclosure worries
Not included in final model
Not included in final model
0.002
1.54
Sexual function
Not included in final model
Not included in final model
Overall function
Not included in final model
Not included in final model
Medication concerns
Not included in final model
Not included in final model
Financial worries
Provider trust
*Bold is statistically significant p < 0.05
Results (8): Multivariate logistic model
Odds of feeling much BETTER off
Unadjusted OR
(95%CI)
Adjusted OR
(95%CI)
2.00 (1.35-2.96)
1.44 (0.90-2.30)
0.69 (0.47-1.00)
0.60 (0.40-0.90)
Depression
0.60 (0.42-0.87)
0.77 (0.52-1.14)
QoL Overall function
1.09 (1.01-1.17)
QoL Life satisfaction
1.17 (1.07-1.29)
QoL Health worries
1.08 (1.01-1.16)
Food secure
Stable housing
QoL Financial worries
1.24 (1.15-1.34)
*Bold is statistically significant p < 0.05
1.19 (1.09-1.29)
Conclusions
All HIV health variables showed
statistically significant associations with
food security and stable housing
Neighbourhood
Perceptions
Social factors
• Food security
• Stable housing
• Gender
• CD4
• Employment
• Viral load suppression
• Education
• Depression
• Drug use
• On HAART
• QoLife Components
Conclusions

All HIV health variables showed statistically significant associations with food
security and stable housing
Food security and stable housing are key
factors influencing perceptions
of
Neighbourhood
Social factors
neighbourhood
quality
and cohesion
Perceptions
• Problems
• Cohesion
• Standard of Living
• Food security
• Stable housing
• Gender
• Employment
• Education
• Drug use
• QoLife Components
Conclusions


All HIV health variables showed statistically significant associations with food
security and stable housing
Food security and stable housing are key factors influencing perceptions of
neighbourhood quality and cohesion
Further research needed to understand the
causal relationships
between
Neighbourhood
Social factors
Perceptions
neighbourhood
perceptions and clinical
measures
• Problems
• Cohesion
• Standard of Living
• CD4
• Viral load suppression
• Depression
• On HAART
Recommendations

All clinical measures and other social factors
showed statistically significant associations with
food security and stable housing

Further research needed to better understand the
causal relationships between neighbourhood
perceptions and clinical measures
Thank You