The HIV Care Continuum and Health Policy: Changes through Context and Geography

艾滋病毒护理连续体和卫生政策：环境和地理的变化

基本信息

批准号：
9410134
负责人：
Peter F Rebeiro
金额：
$ 12.45万
依托单位：
VANDERBILT UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-05 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9410134
关键词：
AIDS/HIV problem Accounting Acquired Immunodeficiency Syndrome Affordable Care Act American Benchmarking CD4 Lymphocyte Count Canada Caribbean region Caring Central America Characteristics Clinical Collaborations Continuity of Patient Care Country Data Data Sources Demography Diagnosis Disease Disease Outcome Enrollment Epidemiologist Epidemiology Geography Goals Guidelines HIV HIV Infections Health Policy Health Services Accessibility Health Status Health system Healthcare Incidence Individual Information Systems Institute of Medicine (U.S.)International Intervention Latin America Latin American Laws Lead Longitudinal cohort Measures Medicaid Mental disorders Mexico Movement National Health Policy North America Outcome Pan American Health Organization Patients Pattern Persons Policies Policy Maker Population Poverty Process Psychiatric Diagnosis Public Health Quasi-experiment Research Research Design Risk Source South America Specific qualifier value Structure Time Time trend United States Update Viral Vulnerable Populations Work World Health Organization antiretroviral therapy clinical care cohort contextual factors disease transmission epidemiology study geographic difference geographic population health care availability health care disparity health disparity improved insight interest lens mortality novel public health relevance socioeconomics virology

项目摘要

PROJECT SUMMARY (ABSTRACT). The HIV Care Continuum is a compelling epidemiologic framework describing the movement of people living with HIV/AIDS through care, including diagnosis, linkage and retention in care, use of antiretroviral therapy (ART), and ultimately, viral suppression. Health policies may profoundly influence outcomes along the Care Continuum, and these effects may be modified across regions and through individual contexts. In observational cohorts, retention in clinical care, ART use, and viral suppression proportions have varied depending on available data and the population under study. The US National HIV/AIDS Strategy (updated to 2020) and the revised 2013 World Health Organization ART guidelines also reference milestones in the Care Continuum. Because the Patient Protection and Affordable Care Act (ACA) and other national health policies in North and Latin American countries aim to improve healthcare access and reduce health disparities, describing the effect of policy and contextual factors on Care Continuum outcomes in these settings is of great interest to epidemiologists, clinicians, and policy makers. This research seeks to quantify health policy, sociodemographic, contextual, and geographic patterns and correlates of HIV Care Continuum outcomes among HIV-infected persons in the United States (US), Canada, and Mexico. Contextual factors include psychiatric illness, regional poverty, residential urbanicity, and other individual and environmental characteristics. The North American AIDS Cohort Collaboration on Research and Design (NA- ACCORD) and Caribbean, Central and South America network for HIV epidemiology (CCASAnet) provide rich data sources in which to conduct this work. Aim 1 will quantify disparities in Care Continuum outcomes in North and Latin America, assessing health system, demographic, risk, contextual, and geographic differences. Because research into the influence of contextual factors and health system characteristics on Care Continuum outcomes in longitudinal cohorts with clinical care data have been sparse or geographically limited, this analysis will be novel and of significant importance. Aims 2 and 3 will provide inferences about the ACA's effects on improving healthcare among HIV-infected individuals in care in the US. The state-led expansion of Medicaid coverage under the ACA will be used as a quasi-experiment to assess effects on Care Continuum and other HIV disease outcomes, comparing pre-ACA (pre-2014) to ACA implementation periods.

项目摘要（摘要）。 HIV 护理连续体是一个引人注目的流行病学框架，描述了通过护理，包括诊断、联系和治疗，艾滋病毒/艾滋病感染者的流动保留护理、使用抗逆转录病毒疗法 (ART)，以及最终抑制病毒。健康政策可能会对护理连续体的结果产生深远的影响，而这些影响可能会可以跨地区并根据具体情况进行修改。在观察队列中，保留临床护理、ART 使用和病毒抑制比例因可用数据和所研究的人群而异。美国国家艾滋病毒/艾滋病战略（更新至 2020 年）和世界卫生组织 2013 年修订版 ART 指南还参考了护理连续体中的里程碑。因为病人保护和平价医疗法案 (ACA) 以及北部和拉丁地区的其他国家卫生政策美洲国家的目标是改善医疗保健服务并减少健康差距，描述在这些环境中，政策和背景因素对护理连续体结果的影响是流行病学家、临床医生和政策制定者非常感兴趣。本研究旨在量化卫生政策、社会人口统计、背景和 HIV 感染者中 HIV 护理连续体结果的地理模式和相关性美国 (US)、加拿大和墨西哥的人士。背景因素包括精神因素疾病、地区贫困、居住城市化以及其他个人和环境特征。北美艾滋病队列研究与设计合作组织 (NA- ACCORD）和加勒比、中美洲和南美洲艾滋病毒流行病学网络（CCASAnet）提供了丰富的数据源来开展这项工作。目标 1 将量化北美和拉丁美洲护理连续体结果的差异，评估卫生系统、人口、风险、背景和地理差异。因为研究背景因素和卫生系统特征对护理的影响具有临床护理数据的纵向队列的连续结果很少或由于地理上的限制，这种分析将是新颖的并且具有重要意义。目标 2 和 3 将提供有关 ACA 对改善医疗保健的影响的推论在美国接受护理的艾滋病毒感染者中。国家主导的医疗补助覆盖范围扩大 ACA 下的项目将用作准实验，以评估对护理连续体的影响其他 HIV 疾病结果，将 ACA 之前（2014 年之前）与 ACA 实施期间进行比较。