ArticleBMC public health2018
Impact of social determinants on antiretroviral therapy access and outcomes entering the era of universal treatment for people living with HIV in Italy.
Article in BMC public health, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.
- Influence of Material Deprivation on Clinical Outcomes Among People Living with HIV in High-Income Countries: A Systematic Review and Meta-analysis.AIDS and behavior · 2022Pooled it
- Improving social determinants of health significantly reduces AIDS incidence: a modelling study of 1.17 million individuals in Brazil.BMJ global health · 2025Article
- Employment Status and HIV Viral Load in Chilean Adult Population: A Propensity Score Analysis.AIDS and behavior · 2025Article
- High prevalence of late presentation with advanced HIV disease and its predictors among newly diagnosed patients in Kumasi, Ghana.BMC infectious diseases · 2024Article
- Observational
- The effects of social determinants of health on acquired immune deficiency syndrome in a low-income population of Brazil: a retrospective cohort study of 28.3 million individuals.Lancet regional health. Americas · 2023Article
- HIV Care Meets Telehealth: a Review of Successes, Disparities, and Unresolved Challenges.Current HIV/AIDS reports · 2022Review
- mHealth Interventions to Promote Anti-Retroviral Adherence in HIV: Narrative Review.JMIR mHealth and uHealth · 2020Review
- Modelling HIV disease process and progression in seroconversion among South Africa women: using transition-specific parametric multi-state model.Theoretical biology & medical modelling · 2020Article
- Multilevel ordinal model for CD4 count trends in seroconversion among South Africa women.BMC infectious diseases · 2020Article
- Novel health systems service design checklist to improve healthcare access for marginalised, underserved communities in Europe.BMJ open · 2020Article
- Housing First: Unsuppressed Viral Load Among Women Living with HIV in San Francisco.AIDS and behavior · 2019Article
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Authors and funding
13 authors at 8 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSocial determinants are known to be a driving force of health inequalities, even in high income countries. Aim of our study was to determine if these factors can limit antiretroviral therapy (ART) access, outcome and retention in care of people living with HIV (PLHIV) in Italy.
methodsAll ART naïve HIV+ patients (pts) of Italian nationality enrolled in the ICONA Cohort from 2002 to 2016 were included. The association of socio-demographic characteristics (age, sex, risk factor for HIV infection, educational level, occupational status and residency area) with time to: ART initiation (from the first positive anti-HIV test), ART regimen discontinuation, and first HIV-RNA < 50 cp/mL, were evaluated by Cox regression analysis, Kaplan Meier method and log-rank test.
resultsA total of 8023 HIV+ pts (82% males, median age at first pos anti-HIV test 36 years, IQR: 29-44) were included: 6214 (77.5%) started ART during the study period. Women, people who inject drugs (PWID) and residents in Southern Italy presented the lowest levels of education and the highest rate of unemployment compared to other groups. Females, pts aged > 50 yrs., unemployed vs employed, and people with lower educational levels presented the lowest CD4 count at ART initiation compared to other groups. The overall median time to ART initiation was 0.6 years (yrs) (IQR 0.1-3.7), with a significant decrease over time [2002-2006 = 3.3 yrs. (0.2-9.4); 2007-2011 = 1.0 yrs. (0.1-3.9); 2012-2016 = 0.2 yrs. (0.1-2.1), p < 0.001]. By multivariate analysis, females (p < 0.01) and PWID (p < 0.001), presented a longer time to ART initiation, while older people (p < 0.001), people with higher educational levels (p < 0.001), unemployed (p = 0.02) and students (p < 0.001) were more likely to initiate ART. Moreover, PWID, unemployed vs stable employed, and pts. with lower educational levels showed a lower 1-year probability of achieving HIV-RNA suppression, while females, older patients, men who have sex with men (MSM), unemployed had higher 1-year risk of first-line ART discontinuation.
conclusionsDespite median time to ART start decreased from 2002 to 2016, socio-demographic factors still contribute to disparities in ART initiation, outcome and durability.
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