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HIV Mobility and Engagement in Care in TN

HIV Mobility and Engagement in Care in Tennessee

Directors: Aima Ahonkhai, VUMC & Kate Clouse, Nursing

Collaborators: Jessica Perkins, Peabody, Bryan Shepard, VUMC, & Steve Wernke, Arts & Sciences


With a goal of ending the epidemic (EtE), the Department of Health and Human Services proposed an ambitious initiative to reduce new HIV infections in the US by 90% in 10 years. Tennessee (TN) is home to over 16,000 people living with HIV (PLWH), is the site of an EtE hotspot (Memphis), and has underperformed relative to the United States (US) population in key steps along the HIV care continuum. This trend has persisted despite concerted efforts by the TN Department of Health (TDH) to improve these outcomes, leaving TN with a great challenge to reach EtE goals of prompt diagnosis, treatment initiation and long-term care engagement. A growing body of international literature suggests that mobility is a potential barrier to engagement in HIV care and may undermine EtE goals. However, there are few data exploring mobility along PLWH in the US. Understanding the prevalence of mobility and its impact on continuum of care outcomes is particularly important in TN – a state that has the most bordering states in the nation. 

Characterizing & Assessing Mobility in TN

Research Goals: Determine the prevalence and spatial variation of across and within-state mobility among PLWH in TN between 2016 & 2017 and evaluate presence and distribution of hotspots of the most mobile patient subgroups and geographic regions.

Methods: Prevalence of mobility will be determined using Modified Poisson regression. Hot spot analysis will utilize Kernel Density and Local Moran’s I. Spider diagrams will also be generated to visualize change in movement to closest care facility.