Relationships Between Patient Race and Residential Race Context With Missed Human Immunodeficiency Virus Care Visits in the United States, 2010-2015

Kaylee B. Crockett, Cassandra O. Schember, Aihua Bian, Peter F. Rebeiro, Jeanne Keruly, Kenneth Mayer, Christopher Mathews, Richard D. Moore, Heidi Crane, Elvin Geng, Sonia Napravnik, Bryan E. Shepherd, Michael J. Mugavero, Bulent Turan, April C. Pettit

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Racial inequities exist in retention in human immunodeficiency virus (HIV) care and multilevel analyses are needed to contextualize and address these differences. Leveraging data from a multisite clinical cohort of people with HIV (PWH), we assessed the relationships between patient race and residential characteristics with missed HIV care visits. Methods: Medical record and patient-reported outcome (PRO; including mental health and substance-use measures) data were drawn from 7 participating Center for AIDS Research Network of Integrated Clinical Systems (CNICS) sites including N = 20 807 PWH from January 2010 through December 2015. Generalized estimating equations were used to account for nesting within individuals and within census tracts in multivariable models assessing the relationship between race and missed HIV care visits, controlling for individual demographic and health characteristics and census tract characteristics. Results: Black PWH resided in more disadvantaged census tracts, on average. Black PWH residing in census tracts with higher proportion of Black residents were more likely to miss an HIV care visit. Non-Black PWH were less likely to miss a visit regardless of where they lived. These relationships were attenuated when PRO data were included. Conclusions: Residential racial segregation and disadvantage may create inequities between Black PWH and non-Black PWH in retention in HIV care. Multilevel approaches are needed to retain PWH in HIV care, accounting for community, healthcare setting, and individual needs and resources.

Original languageEnglish
Pages (from-to)2163-2170
Number of pages8
JournalClinical Infectious Diseases
Issue number12
StatePublished - Jun 15 2023


  • HIV
  • census tract
  • patient-reported outcomes
  • race
  • retention in care


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