Social determinants of health analysis makes causal inference and requires analytic epidemiology methods.

The growing emphasis on reducing health disparities and addressing social determinants of health (SDH) has prompted many national and local health agencies to report population health data by SDH measures. However, many agencies rely on descriptive epidemiology methods for such reports and are susceptible to biased findings due to inadequate confounding control. In this brief analytic essay, using the data presented in an HIV Surveillance Report by the Centers for Disease Control and Prevention (CDC), we demonstrated an example of how reporting health outcomes by SDH with descriptive methods could bias the results and conclusions.

Homelessness and housing assistance among persons with HIV, and associations with HIV care and viral suppression, New York City 2018.

Objectives: To measure housing assistance and homelessness among persons living with HIV (PLWH) and their association with health.

Methods: Exposure categories were: experiencing homelessness (per emergency shelter use or self-report), receiving housing assistance (per housing subsidy) without homelessness, or neither homelessness nor receiving housing assistance. Outcomes were: engagement (≥1 visit) and retention (≥2 visits ≥90 days apart) in HIV-related medical care and one-time (latest viral load) and durable (≥1 viral load test, all suppressed) HIV viral suppression (<200 copies/mL).

Enrollment Length, Service Category, and HIV Health Outcomes Among Low-Income HIV-Positive Persons Newly Enrolled in a Housing Program, New York City, 2014-2017.

To evaluate the impact of duration and service category on HIV health outcomes among low-income adults living with HIV and enrolled in a housing program in 2014 to 2017. We estimated relative risk of engagement in care, viral suppression, and CD4 improvement for 561 consumers at first and second year after enrollment to matched controls through the New York City HIV surveillance registry, by enrollment length (enrolled for more than 1 year or not) and service category (housing placement assistance [HPA], supportive permanent housing [SPH], and rental assistance [REN]). The SPH and REN consumers were enrolled longer and received more services, compared with HPA consumers.

Housing Subsidies and Housing Stability are Associated with Better HIV Medical Outcomes Among Persons Who Experienced Homelessness and Live with HIV and Mental Illness or Substance Use Disorder.

Among 958 applicants to a supportive housing program for low-income persons living with HIV (PLWH) and mental illness or a substance use disorder, we assessed impacts of housing placement on housing stability, HIV care engagement, and viral suppression. Surveillance and administrative datasets provided medical and residence information, including stable (e.g.

Healthcare facility characteristics associated with achievement and maintenance of HIV viral suppression among persons newly diagnosed with HIV in New York City.

Health care facility characteristics have been shown to influence intermediary health outcomes among persons with HIV, but few longitudinal studies of suppression have included these characteristics. We studied the association of these characteristics with the achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older newly diagnosed with HIV between 2006 and 2012. The NYC HIV surveillance registry provided individual and facility data ( = 12,547 persons).

A Randomized Controlled Trial of a Rapid Re-housing Intervention for Homeless Persons Living with HIV/AIDS: Impact on Housing and HIV Medical Outcomes.

We conducted a randomized controlled trial to determine whether, for homeless persons living with HIV/AIDS (PLWHA), rapid re-housing can improve housing and HIV viral suppression more than standard housing assistance. We recruited 236 PLWHA from HIV emergency housing in New York City (NYC) and randomized them to: (1) Enhanced Housing Placement Assistance (EHPA), i.e.

Multilevel Factors Associated with a Lack of Viral Suppression Among Persons Living with HIV in a Federally Funded Housing Program.

Persons with HIV who are receiving housing services often have high rates of engagement in care, yet many are not virally suppressed. We linked data from the New York City Housing Opportunities for Persons with AIDS (HOPWA) program to electronically reported laboratory tests from the HIV surveillance registry to examine factors associated with a lack of viral suppression. Of 1491 HOPWA consumers, 523 (35.

Neighborhood social cohesion and viral suppression after HIV diagnosis.

Social cohesion has varying effects on health. We investigated the association of perceived neighborhood social cohesion with HIV viral suppression using individual-level data from the New York City HIV registry and surveillance-based interviews ( = 92). Suppression was achieved within 12 months of HIV diagnosis by 60 percent of persons perceiving low cohesion and 71 percent of those perceiving high ( = 0.

Reduction in Gaps in High CD4 Count and Viral Suppression Between Transgender and Cisgender Persons Living With HIV in New York City, 2007-2016.

To compare trends in HIV outcomes for cisgender and transgender persons living with HIV (PLWH) in New York City. We used HIV surveillance data for the analysis. We based CD4 count on the last measurement in a calendar year and defined viral suppression as the last viral load being less than or equal to 200 copies per milliliter in the calendar year.

Long-Term Supportive Housing is Associated with Decreased Risk for New HIV Diagnoses Among a Large Cohort of Homeless Persons in New York City.

It is unknown whether providing housing to persons experiencing homelessness decreases HIV risk. Housing, including access to preventive services and counseling, might provide a period of transition for persons with HIV risk factors. We assessed whether the new HIV diagnosis rate was associated with duration of supportive housing.

Brief Report: HIV Prevalence and the Prevalence of Unsuppressed HIV in New York City, 2010-2014.

Background: The widespread use of antiretroviral treatment made HIV prevalence no longer a good measure of population-level transmission risk. The objective of this analysis was to use the prevalence of unsuppressed HIV to describe population-level HIV transmission risk.

Methods: Using New York City (NYC) HIV surveillance data, we reported HIV prevalence and the prevalence of unsuppressed HIV, defined as the number of persons living with HIV with an unsuppressed viral load divided by population size.

Neighborhood Characteristics Associated with Achievement and Maintenance of HIV Viral Suppression Among Persons Newly Diagnosed with HIV in New York City.

We investigated the effect of neighborhood characteristics on achievement and maintenance of HIV viral suppression among New York City (NYC) residents aged 13 years and older diagnosed between 2006 and 2012. Individual records from the NYC HIV surveillance registry (n = 12,547) were linked to U.S.

Diagnosed HIV Infection in Transgender Adults and Adolescents: Results from the National HIV Surveillance System, 2009-2014.

Publications on diagnosed HIV infection among transgender people have been limited to state- or local-level data. We analyzed data from the National HIV Surveillance System and present results from the first national-level analysis of transgender people with diagnosed HIV infection. From 2009 to 2014, HIV surveillance jurisdictions from 45 states plus the District of Columbia identified and reported at least one case of newly diagnosed HIV infection for transgender people; jurisdictions from 5 states reported no cases for transgender people.

Estimated HIV Incidence in the United States, 2003-2010.

Objective: To estimate HIV incidence in the United States using a newly developed method.

Methods: The analysis period (2002-2011) was broken down into 3-year periods with overlaps, and HIV incidence was estimated based on the relationship between number of new diagnoses and HIV incidence in each of these 3-year periods, by assuming that all HIV infections would eventually be diagnosed and within each 3-year period HIV incidence and case finding were stable.

Results: The estimated HIV incidence in the United States decreased from 52,721 (range: 47,449-57,993) in 2003 to 39,651 (range: 35,686-43,617) in 2010, among males from 38,164 (range: 35,051-42,840) to 33,035 (range: 29,088-35,553), and among females from 13,557 (range: 12,133-14,830) to 6616 (range: 5825 to 7120).

Persons Living With HIV in the United States: Fewer Than We Thought.

Objectives: To estimate the number of persons living with HIV (PLWH) in the United States and to describe their care status.

Methods: Estimates of diagnosed PLWH in New York City and other 19 jurisdictions based on HIV case reporting were compared with those based on HIV laboratory reporting. A revised HIV care continuum was constructed based on previously published data.

The Association Between Neighborhood Poverty and HIV Diagnoses Among Males and Females in New York City, 2010-2011.

Objective: We assessed the association of neighborhood poverty with HIV diagnosis rates for males and females in New York City.

Methods: We calculated annual HIV diagnosis rates by ZIP Code, sex, and neighborhood poverty level using 2010-2011 New York City (NYC) HIV surveillance data and data from the U.S.

Persistent Racial Disparities in HIV Infection in the USA: HIV Prevalence Matters.

Objectives: Despite increased funding and efforts to prevent and control HIV infections in the black and Hispanic communities, racial disparities persist in the USA. We used a mathematical model to explain the phenomena.

Methods: A mathematical model was constructed to project HIV prevalence ratio (PR), incidence rate ratio (IRR), and HIV-specific mortality rate ratio (MRR) among blacks and Hispanics vs.

HIV Diagnoses and Care Among Transgender Persons and Comparison With Men Who Have Sex With Men: New York City, 2006-2011.

Objectives: We measured HIV care outcomes of transgender persons, who have high HIV infection rates but are rarely distinguished from men who have sex with men (MSM) in HIV surveillance systems.

Methods: New York City's surveillance registry includes HIV diagnoses since 2000 and HIV laboratory test results for transgender persons since 2005. We determined immunological status at diagnosis, delayed linkage to care, and nonachievement of viral suppression 1 year after diagnosis for transgender persons diagnosed with HIV in 2006 to 2011 and compared transgender women with MSM.

Comparison of indicators measuring the proportion of human immunodeficiency virus-infected persons with a suppressed viral load.

Purpose: The Centers for Disease Control and Prevention uses the last viral load to estimate the proportion of human immunodeficiency virus (HIV)-infected persons with a suppressed viral load. Several recent studies report that it may overestimate viral suppression in the population and have suggested using sustained viral suppression. The objective of this analysis is to compare these indicators.

Foreign-Born Persons Diagnosed with HIV: Where are They From and Where Were They Infected?

We sought to calculate rates of HIV diagnoses by area of birth among foreign-born persons in a high-incidence US city with many immigrants, and determine probable place of HIV acquisition. Data from the New York City HIV surveillance registry and American Community Survey were used to calculate HIV diagnosis rates by area of birth and determine probable place of HIV acquisition among foreign-born diagnosed in 2006-2012. HIV diagnosis rates varied by area of birth and were highest among African-born persons; absolute numbers were highest among Caribbean-born persons.

Proportions of patients with HIV retained in care and virally suppressed in New York City and the United States: higher than we thought.

Background: The purpose of this analysis is to compare 2 newly developed methods (a "likelihood" method and a "weighting" method) with the widely used method (the "include-all" method) to estimate the proportions of HIV-infected persons retained in care and virally suppressed in New York City (NYC).

Methods: The NYC HIV registry data were used for the analysis. The include-all method included all patients in the denominator who were diagnosed and/or receiving care in NYC and not known to be dead by December 31, 2012.

Monitoring outcomes for newly diagnosed and prevalent HIV cases using a care continuum created with New York city surveillance data.

Background: The HIV care continuum has been used to show the proportion of persons living with HIV/AIDS (PWHA) who are engaged in each stage of HIV care. We present 1 care continuum for persons newly diagnosed with HIV and 1 for PWHA using New York City HIV surveillance registry data.

Methods: Persons newly diagnosed with HIV in 2011 or PWHA as of December 31, 2011, were included.