Deconstructing HIV Disparities: Multistate Study of Data, Outcomes and Mediators

解构艾滋病毒差异：数据、结果和中介因素的多州研究

• 批准号: 9763431
• 负责人: Kathleen Ann McManus
• 金额: $ 19.21万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-14 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9763431
• 关键词: AIDS/HIV problem; Achievement; Acquired Immunodeficiency Syndrome; Advisory Committees; Affect; Affordable Care Act; African American; Age Factors; Award; Basic Science; Caring; Characteristics; Client; Clinic; Clinical Research; Collaborations; Communicable Diseases; Communities; Data; Data Analyses; Data Collection; Data Quality; Demographic Factors; Development Plans; Eligibility Determination; Enrollment; Epidemiology; Ethnic Origin; Failure; Funding; Future; Goals; HIV; HIV Infections; Health; Health Care Costs; Health Insurance; Health Policy; Health Sciences; Healthcare Systems; Individual; Infection; Institution; Intervention; K-Series Research Career Programs; Lead; Longevity; Low income; Mediator of activation protein; Medicaid; Mentors; Mentorship; Modeling; Monitor; Outcome; Pathway interactions; Pharmaceutical Preparations; Policies; Population; Population Programs; Public Health; Race; Research; Research Personnel; Resource Allocation; Scientist; Selection Bias; Service delivery model; South Carolina; Southeastern United States; Statutes and Laws; Time; Training; Translations; Uninsured; United States; Universities; Viral; Virginia; Work; antiretroviral therapy; base; career; career development; cohort; design; disparity reduction; econometrics; epidemiology study; experience; federal policy; follow-up; group intervention; health care delivery; health disparity; health plan; high risk; improved; intravenous drug use; prevent; programs; secondary analysis; skills; transmission process

PROJECT SUMMARY/ABSTRACT This K08 Mentored Career Development Award's overall objective is to support Dr. Kathleen A. McManus at the outset of her career, providing sufficient time to focus her research on critical issues in the intersection of epidemiology, HIV health outcomes, and health policy. Her Career Development Plan will use the context of her research for three goals: 1) master skills (design, analysis, and interpretation) of quantitative epidemiologic research; 2) gain expertise in the application of these analyses to state and federal health policy; and 3) independence. Her overarching K08 research goal is to deconstruct HIV viral suppression disparities. Specifically, she will perform secondary analyses of multistate (Virginia and South Carolina) data to 1) identify demographic and healthcare system-level factors associated with loss to follow-up of AIDS Drug Assistance Program (ADAP) clients; 2) estimate the effect of Affordable Care Act (ACA) Qualified Health Plan status on sustained individual HIV viral suppression and assess disparities in outcomes among ADAP clients; and 3) quantify the state/population level effect of modifiable healthcare delivery factors as mediators that impact disparities in viral suppression by race/ethnicity among ADAP clients. HIV viral suppression is a key outcome. It benefits individuals' longevity as well as the community since it is associated with decreases in new cases of HIV infection. This research will inform policies to reduce disparities for low-income PLWH served by ADAP. In order to monitor progress toward achieving HIV goals, states need accurate, timely data. If loss to follow-up results in data that is not missing completely at random, this could result in biased data and suboptimal policies. Understanding factors affecting loss to follow-up will help ADAPs to identify priority groups for interventions and will allow for adjustment of future analyses for selection bias. Studying this multistate ADAP cohort's ACA experience is applicable to ~225,000 ADAP clients across the nation. If the ACA is changed or repealed, or if Virginia or South Carolina expand Medicaid, the project will be adjusted to study the impact of those changes. This proposal will provide important information for state and federal policy and could become a model for HIV analyses in other states and at the federal level. It fulfills main components of the United States' National HIV/AIDS Strategy by identifying strategies to strengthen the timely availability and use of high quality data and by characterizing modifiable factors' effects on disparities that can be targeted for interventions. This proposal benefits from a strong advisory team of leading researchers with expertise in epidemiology, casual inference, econometrics, health outcomes, health policy, and HIV outcomes. Drawing from the mentorship, collaboration, and support of the Divisions of Infectious Diseases and Public Health Sciences, and state partners in Virginia and South Carolina, the University of Virginia is an ideal institution for this award with the long-term goal that Dr. McManus will become an independent clinician-researcher focused on improving health outcomes for people living with HIV by optimizing data collection and analysis, and translation of data into policy and action.

项目摘要/摘要 这个K08指导的职业发展奖的总体目标是支持Kathleen A. McManus博士 她职业生涯的从来，提供了足够的时间将她的研究集中在关键问题上 流行病学，艾滋病毒健康成果和健康政策。她的职业发展计划将利用她的背景 针对三个目标的研究：1）定量流行病学的主要技能（设计，分析和解释） 研究; 2）在将这些分析应用于州和联邦卫生政策方面获得专业知识； 3） 独立。她的总体K08研究目标是解构HIV病毒抑制差异。 具体而言，她将对多态（弗吉尼亚州和南卡罗来纳州）数据进行次要分析1）确定 人口和医疗保健系统级别的因素与艾滋病随访毒品援助有关 程序（ADAP）客户端； 2）估计可负担医疗法案（ACA）合格的健康计划状况对的影响 持续的单个艾滋病毒抑制并评估ADAP客户结果的差异； 3） 量化可修改的医疗保健输送因子的状态/人口水平的影响，作为影响的调解人 ADAP客户在种族/种族中抑制病毒的差异。艾滋病毒抑制是关键结果。它 使个人的寿命和社区造福 艾滋病毒感染。这项研究将告知政策，以减少ADAP服务的低收入PLWH的差异。在 为了监控实现艾滋病毒目标的进度，各州需要准确，及时的数据。如果损失跟进 导致数据并非随机丢失的数据，这可能导致偏见的数据和次优政策。 了解影响损失对后续行动的因素将有助于适应以确定干预措施的优先组和 将允许调整未来的选择偏差分析。研究此多阶段ADAP队列的ACA 经验适用于全国约225,000个ADAP客户。如果ACA更改或废除，或者 弗吉尼亚州或南卡罗来纳州扩大了医疗补助，该项目将进行调整以研究这些变化的影响。 该提案将为州和联邦政策提供重要信息，并可能成为艾滋病毒的典范 在其他州和联邦一级进行分析。它满足了美国国家的主要组成部分 艾滋病毒/艾滋病策略通过确定加强及时可用性和使用高质量数据的策略以及 通过表征可修改因素对可以针对干预措施的差异的影响。这个建议 由强大的顾问团队组成的领先研究人员，具有流行病学专业知识，随意推断， 计量经济学，健康结果，健康政策和HIV成果。从指导，协作中汲取灵感， 并支持传染病和公共卫生科学的划分，以及弗吉尼亚州的国家合作伙伴 弗吉尼亚大学南卡罗来纳州南卡罗来纳州是该奖项的理想机构，其长期目标是博士。 麦克马纳斯（McManus）将成为一名专注于改善人们健康成果的独立临床研究者 通过优化数据收集和分析以及将数据转换为政策和行动，与艾滋病毒一起生活。