Neighborhood-Level Concentrated Poverty and Human Immunodeficiency Virus Testing among Primary Care Patients

Background The U.S. Centers for Disease Control and Prevention recommends that all patients seeking care in most healthcare settings routinely undergo human immunodeficiency virus testing during their healthcare visits;... [ view full abstract ]

Background
The U.S. Centers for Disease Control and Prevention recommends that all patients seeking care in most healthcare settings routinely undergo human immunodeficiency virus testing during their healthcare visits; however, need for and access to testing may vary depending on whether a patient lives in an area of concentrated poverty.

Purpose
This study explored the prevalence of concentrated poverty (i.e., ≥ 40% of residents in a tract live in poverty) among primary care patients and examined its relationship to human immunodeficiency virus testing during a recent primary care visit.

Methods
We conducted a cross-sectional, multilevel analysis among primary care patients (N= 1,627,642) enrolled in a major managed care organization in southern California. We linked detailed clinical information from each patient’s electronic medical record to census-derived socioeconomic indicators for the tract in which each patient lived. We conducted multivariable, random-effects logistic regression analysis to examine relationships between concentrated poverty and testing while controlling for individual-level covariates.

Results
Overall, levels of human immunodeficiency virus testing (5.3%; n=86,339) and concentrated poverty (1.8%; n=29,695) were low. A greater proportion of patients living in areas of concentrated poverty than in other neighborhoods tested for human immunodeficiency virus infection during an index visit (8.4% vs. 5.2%). By race/ethnicity, greater proportions of blacks (4.0%, n=6,390) and Spanish speaking Latinos (4.5%, n=8,046) resided in neighborhoods characterized by concentrated poverty. In the adjusted analyses, patients living in areas of concentrated poverty had slightly higher odds (odds ratio = 1.061; 95% confidence interval = 1.008-1.117) of testing during an index visit compared to similar patients in other neighborhoods.

Discussion/Conclusion
The human immunodeficiency virus testing behaviors of primary care patients may vary depending on the pervasiveness of poverty in their neighborhoods; future research should clarify whether this reflects a greater need for testing among these patients or better access to it.