Metropolitan Trajectories of HIV Epidemics, Drug Use, and Responses in US Key Populations

美国重点人群中艾滋病毒流行、药物使用和反应的大都市轨迹

• 批准号: 8850413
• 负责人: Hannah LF Cooper
• 金额: $ 89.86万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-01 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8850413
• 关键词: AIDS diagnosis; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Affect; Age; Area; Cohort Studies; Communicable Diseases; Communities; Community Actions; Diagnosis; Disease; Drug usage; Ecology; Epidemic; Epidemiology; Ethnic Origin; Fostering; Funding; Gender; HIV; Health; Heterosexuals; Incidence; Individual; Infection; Intervention; Knowledge; Life; Measures; Modeling; National Institute of Drug Abuse; Needle-Exchange Programs; Newly Diagnosed; Outcome; Paper; Pharmaceutical Preparations; Policies; Policy Research; Population; Population Dynamics; Prevalence; Process; Program Development; Publishing; Race; Research; Research Design; Research Personnel; Resources; Science; Structure; Subgroup; Symbiosis; Time; Virus; Work; Writing; design; geographic difference; high risk; intervention effect; mathematical model; men who have sex with men; metropolitan; mortality; novel; prevent; programs; response; theories; transmission process

DESCRIPTION (provided by applicant): For over 30 years, almost all studies of HIV/AIDS epidemics and programs have focused on one key population (KP) in isolation from other KPs. This siloed approach has significantly limited scientific understanding of the fundamental dynamics of HIV/AIDS epidemics, and has led us to miss vital opportunities to prevent new infections. Published and preliminary analyses by this team and others suggest that HIV/AIDS epidemics and programs in one KP may affect epidemics and programs in other KPs. For example, our analyses of the 96 largest US metropolitan statistical areas (MSAs) suggest that HIV prevalence among men who have sex with men (MSM) predicts HIV prevalence among people who inject drugs (PWID), and that HIV prevalence among PWID predicts AIDS incidence among heterosexuals. Studies of sexual networks also suggest that mixing occurs across KPs. Likewise, programs targeting one KP may affect epidemics in other KPs: we have found that the presence of syringe exchange programs predicts later lower AIDS incidence and mortality rates among heterosexuals in these MSAs. A key principle undergirding these findings has been that the HIV/AIDS virus, like many infectious diseases, affects populations, not just individuals and networks. Using this population-level approach, we will pioneer a novel line of high-impact epidemiologic, programmatic, and policy research on whether and how HIV/AIDS epidemics and programs affect one another across three KPs (i.e., MSM, PWID, and heterosexuals) in the US. This longitudinal (1992-2015) cohort study of the 96 largest MSAs in the US will (1) create MSA-level annual estimates of HIV/AIDS epidemic outcomes for each KP and KP subgroup (defined by race/ethnicity, age, and, for heterosexuals and PWID, gender), and of HIV/AIDS- related program presence and coverage for these KPs and KP subgroups. It will then describe how each of these epidemiologic and program variables varies across time and MSAs. Using these epidemiologic and programmatic estimates, it will (2) determine if and how HIV/AIDS epidemics in one KP affect and are affected by epidemics in other KPs, both overall and across KP subgroups; and (3) discover determinants of the presence and coverage of HIV/AIDS-related program presence and coverage for each KP and KP subgroup. Aim 2 will be guided by the Political Ecology of Disease and the Dialectical Model of Epidemics frameworks; Aim 3 will be guided by the related Theory of Community Action. By achieving these aims and embracing a population-level perspective, the proposed study will advance a new paradigm of research that will discover and describe how cross-KP dynamics help drive HIV/AIDS epidemics in the US. Findings will also open up new arenas for intervention, including interventions that seek to prevent epidemics in one KP from affecting epidemics in other KPs, and that maximize positive effects of interventions across KPs. A team of researchers with deep knowledge of epidemics and programs within each KP has joined forces to integrate their KP- specific expertise to conceptualize and study these cross-KP interactions.

描述（由申请人提供）：30多年来，几乎所有对艾滋病毒/艾滋病流行病和计划的研究都集中在一个关键人群（KP）上，与其他KP隔离。这种孤立的方法对艾滋病毒/艾滋病流行病的基本动态的科学理解极大地限制了，并导致我们错过了预防新感染的重要机会。该团队和其他人的发表和初步分析表明，一个KP中的艾滋病毒/艾滋病流行病和计划可能会影响其他KP的流行病和计划。例如，我们对96个美国大都市统计区（MSA）的分析表明，与男性发生性关系的男性（MSM）的艾滋病毒患病率预测了注射药物（PWID）的人的艾滋病毒患病率，并且PWID之间的艾滋病毒患病率预测了艾滋病毒的患病率。性网络的研究还表明，在KPS之间进行混合。同样，针对一个KP的计划可能会影响其他KPS的流行病：我们发现，注射器交换计划的存在预测，这些MSA中异性恋者的较低艾滋病的发病率和死亡率较低。这些发现的主要原则是，像许多传染病一样，艾滋病毒/艾滋病病毒会影响人群，而不仅仅是个人和网络。使用这种人群级别的方法，我们将在美国开创一系列新型的高影响力流行病学，程序化和政策研究。 This longitudinal (1992-2015) cohort study of the 96 largest MSAs in the US will (1) create MSA-level annual estimates of HIV/AIDS epidemic outcomes for each KP and KP subgroup (defined by race/ethnicity, age, and, for heterosexuals and PWID, gender), and of HIV/AIDS- related program presence and coverage for these KPs and KP亚组。然后，它将描述这些流行病学和程序变量如何在时间和MSA之间变化。使用这些流行病学和程序化估计值，它将（2）确定一个KP的艾滋病毒/艾滋病流行病是否以及如何受到其他KP的流行病的影响，无论是整体和跨KP亚组的； （3）发现每个KP和KP亚组的艾滋病毒/艾滋病相关程序的存在和覆盖范围的决定因素。 AIM 2将以疾病的政治生态和流行框架的辩证模型为指导； AIM 3将以相关的社区行动理论为指导。通过实现这些目标并拥抱人群级别的观点，拟议的研究将推进新的研究范式，该研究将发现和描述跨KP动力学如何帮助推动美国的艾滋病毒/艾滋病流行病。调查结果还将为干预措施开辟新的领域，包括试图防止一个KP中流行病的干预措施，影响其他KP的流行病，并最大程度地影响整个KP的干预措施的积极影响。对每个KP中的流行病和计划有深刻了解的研究人员团队已联合起来，将其KP特定专业知识整合起来，以概念化和研究这些交叉KP相互作用。