Date of Award

2018

Document Type

Open Access Dissertation

Department

Epidemiology and Biostatistics

First Advisor

Jan Eberth

Abstract

The main objectives of this dissertation were to provide a complete depiction of the prevalence of HIV across the United States and to assess HIV testing trends among various subpopulations. Additionally, we focused on measuring spatial access to HIV testing resources across the U.S. South, where HIV is rapidly becoming more burdensome and resources have historically been allocated disproportionately. We sought to identify disparate populations and locations that require further focus moving forward to stem the HIV epidemic. We utilized a variety of data sources such as the Behavioral Risk Factor Surveillance System (BRFSS) which was used to assess national temporal trends of reported HIV testing among different subpopulations. We used geocoded HIV facility locations, obtained from the Centers for Disease Control and Prevention (CDC), to examine spatial accessibility to HIV testing facilities with a focus on rurality, across the U.S. south. We applied small area estimation (SAE) techniques to model HIV prevalence at the county-level, using auxiliary covariate data and HIV data released by the CDC, to assess the burden of HIV at the local level. Our study found that as rurality increased, as did suboptimal access to HIV testing facilities across the U.S. south, particularly in more socioeconomically deprived areas. Populations farther than 30 minutes from a testing facility, had lower average median household incomes, higher poverty rates and higher rates of being uninsured. We also vi found nationwide that females, individuals with health insurance, those who identify as lesbian/gay and partake in high risk behaviors were more likely to report being tested for HIV compared to males, individuals without insurance, those who identify as straight and those who do not partake in high risk behaviors. Our findings also confirmed previous research showing the highest prevalence of HIV along the coastlines and consistently across the U.S. south. Overall, the work from this dissertation indicates the continued need for targeted interventions, outreach efforts and policies to address disparities regarding the utilization of HIV testing across the country, particularly along the coasts and in the rural south where there is a disproportionate level of access to HIV testing services.

Available for download on Thursday, February 20, 2020

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