Degree Name

DrPH (Doctor of Public Health)


Public Health

Date of Award


Committee Chair or Co-Chairs

Megan Quinn

Committee Members

Shimin Zheng, Rob Pack, Jonathan Moorman


Introduction: Factors contributing to the HIV continuum of care (HCC) for adults in Tennessee (TN) have not been studied in depth with known predictors for HIV risk, specifically adverse childhood experiences (ACEs), among low annual income or sexual minority groups [lesbian, gay, bisexual, or transgender (LGBT)].

Methods: A mixed methods study design was used to assess factors related to the HCC. Quantitative analysis used the TN Behavioral Risk Factor Surveillance System data to examine at risk and ever tested for HIV, to (1) investigate ACEs among adults with low-income (

Results: Quantitative results found that among LGBT (N=262) and low-income (N=3258) adults living in TN, the proportion at risk for HIV and ever tested for HIV was highest in East TN (LGBT at risk – 45.53%; LGBT ever tested for HIV – 58.32%; low-income at risk – 8.14%; low-income ever tested – 52.05%). Among adults with low-income, MLR revealed 1-3 ACEs decreased the odds of HIV risk in East (aOR: aOR: 0.54, 95% CI: 0.52-0.56) whereas 4+ ACEs increased odds of being at risk in Middle TN by 32 times (aOR: 31.86, 95% CI: 29.83-34.02) compared to adults with no ACEs. Among LGBT, MLR estimated odds of HIV testing were 33 times higher among adults in West TN at risk for HIV compared to those not at risk (West TN, aOR: 33.59; 95% CI: 31.97-35.96). Qualitative analysis results provided a 55-question survey related to ACEs, HIV transmission risk, and barriers to HIV care.

Discussion: Regional differences were revealed among LGBT and low-income populations; low-income and ACEs were associated with being at risk and ever tested for HIV. ACEs and HCC surveillance were considered relevant by PLWH at the clinic. Additional research including piloting the survey and longitudinal studies are necessary to improve the HCC and quality of life among PLWH in TN.

Document Type

Dissertation - embargo


Copyright by the authors.

Available for download on Friday, September 15, 2023

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Epidemiology Commons