October 10, 2023 | Erin Bluvas, bluvase@sc.edu

Xueying Yang, assistant professor of health promotion, education, and behavior (HPEB), has been awarded $400K from the National Institute of Nursing Research. She will use the two-year R21 grant to identify patterns and predictors of racial/ethnic disparities in the HIV care continuum in the South.

“The HIV care continuum is a framework for managing HIV infection – tracking the progression of people living with HIV from diagnosis to linkage to care, retention in care, antiretroviral therapy and finally viral suppression – to prevent the progression and spread of this disease,” Yang says. “Unfortunately, we continue to see racial and ethnic health disparities at every step of the continuum.” 

 

Approximately 38,000 Americans are diagnosed with HIV each year.

The HIV care continuum is a critical component of the federal campaign, Ending the HIV Epidemic, which aligns with the UNAIDS’ 90-90-90 goals to reduce the rate of new HIV infection in the United States. New HIV treatment and prevention strategies have reduced the number of new diagnoses over the past 40 years, yet this progress has stalled despite important biomedical advances. Approximately 38,000 Americans continue to be diagnosed each year.

Subsequent steps in the HIV care continuum show significant disparities between different racial/ethnic groups. Compared to their white counterparts, African American and Latino people living with HIV are less likely to be linked to HIV care, to receive any care, to be retained in care, and to achieve viral suppression.

Researchers have identified HIV stigma, homophobia/transphobia, increased use of injected drugs, lack of access to treatment/prevention and other factors as the primary drivers of the continued spread. As one of the seven states targeted by campaign (due to our high levels of HIV in rural areas), South Carolina is the perfect home for the Center for Healthcare Quality and the Big Data Health Science Center that Yang collaborates with on this work.

Both led by HPEB professor Xiaoming Li, these researchers have been studying treatment gaps among South Carolinians living with HIV since 2017. Using a big data approach, they analyze electronic health records and other data sources to reveal patterns down to the county level. Their work has also revealed the various factors and barriers (e.g., community, social, structural racism, health care access) that influence these trends.

Yang’s new project will build on this work by creating a county-level racial/ethnic disparity index for each of the key outcomes of the HIV care continuum: testing, timely diagnosis, viral suppression. The team will drill even deeper into their existing data by examining the temporal patterns of each index over time and developing models to predict related changes.

“The new knowledge generated by these tools will allow us to confirm some existing risk factors and reveal unknown, possibly intersecting, ones that contribute to racial and ethnic disparities in the HIV care continuum,” Yang says. “It will also assist health departments in identifying counties with worsening disparities for targeted inventions while informing public and policymakers of needed investments and supports to address health inequalities in the state.”   

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