{"doi":"10.3389/fpubh.2022.1013967","title":"Moderation effect of community health on the relationship between racial/ethnic residential segregation and HIV viral suppression in South Carolina: A county-level longitudinal study from 2013 to 2018","abstract":"Background: Viral suppression is the ultimate goal of the HIV treatment cascade and a primary endpoint of antiretroviral therapy. Empirical evidence found racial/ethnic disparities in viral suppression among people living with HIV (PWH), but the evidence of the relationship between racial/ethnic residential segregation and place-based viral suppression is scarce. Further exploring potential structural moderators in this relationship has substantial implications for healthcare policymaking and resource allocation. The current study aimed to investigate the spatial-temporal disparities in the HIV viral suppression rate across 46 counties in South Carolina from 2013 to 2018. We also examined the impact of racial/ethnic residential segregation and the moderation effect of community health, one measurement of community engagement and volunteerism. Methods: The proportion of PWH who achieved viral suppression for each county and calendar year was calculated using de-identified electronic medical records. The isolation index was calculated and used to measure racial/ethnic residential segregation. The community health index and other county-level factors were directly extracted from multiple publicly available datasets. We used geospatial mapping to explore the spatial-temporal variations of HIV viral suppression rates. Hierarchical quasi-binominal regression models were used to examine the impacts of racial/ethnic residential segregation on county-level viral suppression rate by the extent of community health. Results: From 2013 to 2018, the average viral suppression rate across 46 counties in SC increased from 64.3% to 65.4%. Regression results revealed that counties with high racial/ethnic residential segregation were more likely to have a low viral suppression rate (β = -0.56, 95% CI: -0.75 to -0.37). In counties with high levels of community health, the impact of racial/ethnic residential segregation on viral suppression rate decreased as compared with those with low levels of community health (β = 5.50, 95% CI: 0.95-10.05). Conclusions: Racial/ethnic residential segregation acts as a structural barrier to placed-based viral suppression rates and compromises the goal of the HIV treatment cascade. Concentrated and sustained county-level interventions aiming to improve community health can be practical approaches to promote health equity in HIV treatment and care.","journal":"Frontiers in Public Health","year":2023,"id":365095,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9552,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":779175,"name":"Jiajia Zhang","orcid":"0009-0007-6884-0638","position":1,"is_corresponding":false},{"id":329427,"name":"Xueying Yang","orcid":"0000-0001-6788-0688","position":2,"is_corresponding":false},{"id":680275,"name":"Xiaowen Sun","orcid":"0000-0003-1102-350X","position":3,"is_corresponding":false},{"id":295081,"name":"Zhenlong Li","orcid":"0000-0002-8938-5466","position":4,"is_corresponding":false},{"id":511431,"name":"Chengbo Zeng","orcid":"0000-0002-3512-1115","position":5,"is_corresponding":false},{"id":376172,"name":"Huan Ning","orcid":"0000-0003-3698-3240","position":6,"is_corresponding":false},{"id":295082,"name":"Sharon Weissman","orcid":"0000-0002-2854-5745","position":7,"is_corresponding":false},{"id":295083,"name":"Bankole Olatosi","orcid":"0000-0002-8295-8735","position":8,"is_corresponding":false},{"id":42140,"name":"Xiaoming Li","orcid":"0000-0002-5555-9034","position":9,"is_corresponding":false},{"id":1113296,"name":"Fanghui Shi","orcid":"0000-0002-5603-5398","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-19T01:14:46.760245Z","pmid":"36699939","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}