The science for the last mile: Enhanced epidemiologic surveillance to accelerate HIV elimination

最后一英里的科学：加强流行病学监测以加速消除艾滋病毒

• 批准号: 9926504
• 负责人: Paul Douglas Wesson
• 金额: $ 13.58万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-03-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9926504
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Address; African American; Area; Caring; Case-Control Studies; Characteristics; Cities; Cluster Analysis; Communicable Diseases; Complex; County; Data; Data Collection; Data Sources; Diagnosis; Discrimination; Disease model; Economics; Environment; Epidemic; Epidemiologic Methods; Epidemiologic Monitoring; Epidemiology; Ethnic Origin; Event; Exposure to; Female; Food; Foundations; Goals; HIV; HIV Antibodies; HIV Infections; HIV diagnosis; Harm Reduction; Health; Health Services; Health system; Incidence; Individual; Inequality; Infection; Interruption; Intervention; Knowledge; Laboratories; Link; Machine Learning; Matched Case-Control Study; Measures; Mediation; Medical; Methodology; Methods; Minority; Modeling; Molecular; Molecular Epidemiology; Needle Sharing; Needle-Exchange Programs; Pathway interactions; Persons; Phylogenetic Analysis; Population; Population Heterogeneity; Population Sizes; Population Surveillance; Populations at Risk; Positioning Attribute; Prevalence; Public Health; Race; Reporting; Reproducibility; Research; Research Design; Research Personnel; Residual state; Resources; Risk; Risk Factors; San Francisco; Science; Signal Transduction; Site; Social Behavior; Social Environment; Social Network; Source; Statistical Methods; Statistical Models; Stress; Structure; System; Techniques; Testing; Training; Training Programs; United States; Universal Coverage; Viral; Viral Load result; Vulnerable Populations; Woman; Work; antiretroviral therapy; career; diverse data; ethnic minority population; evidence base; experience; falls; gender disparity; health care availability; health care service; health disparity; high risk population; housing instability; improved; infection rate; infection risk; innovation; insight; multidisciplinary; novel; pre-exposure prophylaxis; prevention service; racial and ethnic; racial and ethnic disparities; racial minority; response; scale up; semiparametric; sex; sexual minority; social; social epidemiology; social stigma; social structure; sociodemographics; success; surveillance data; testing services; theories; tool; transmission process

PROJECT SUMMARY/ABSTRACT Cities account for a large proportion of the global population of people living with HIV. As a result, Cities have become the focus of UNAIDS's “Fast Track” approach to ending the AIDS epidemic through targeted scale-up of prevention and testing services. In the United States, HIV surveillance data indicates a shifting composition of the population of people newly infected with HIV, with females and minority populations accounting for disproportionate rates of infection. These emerging health disparities in HIV incidence suggest that the largely successful “Getting to Zero” public health initiatives (e.g. rapid expansion of pre-exposure prophylaxis [PrEP], needle exchange and safe injecting sites, etc.) are not reaching the most vulnerable populations. Leveraging routinely collected surveillance data paired with primary data collection, the major goal of this research is to identify the residual drivers of HIV infection in Fast Track cities, using San Francisco as a test case. This proposal seeks to provide multidisciplinary methodological and theoretical training to investigate the scientific knowledge gap of ongoing HIV transmission in the era of “Getting to Zero.” The proposed training areas are: (1) semi-parametric statistical modeling and machine learning in order to improve the accuracy and precision of population size estimation methods; (2) molecular epidemiology and phylogenetic techniques to assess the relatedness of HIV viral sequences between individuals, inferring a shared source of infection; and (3) minority stress theory to measure the (socio-structural) characteristics of the environment and relate these structural exposures to disparities in HIV infection. Aligned with the training components, the research goals of this study are to: (a) estimate how many people are living with HIV in San Francisco and quantify the magnitude of disparities in infection rates and access to health care services; (b) identify the sociodemographic correlates of membership to a transmission cluster; and (c) identify the socio-structural facilitators of recent HIV infections, particularly among minority populations, using a case-control study design. The evidence generated from this work could have a direct impact on San Francisco's Getting to Zero campaign and inform novel intervention targets for other Fast Track cities. Additionally, the exceptional methodological and practical experience gained from this project will position the candidate for an impactful career as an independent researcher.

项目摘要/摘要 城市占全球艾滋病毒的全球人口中很大一部分。结果，城市有 成为Unaids“快速轨道”方法的重点，以通过有针对性的规模结束艾滋病流行 预防和测试服务。在美国，艾滋病毒监视数据表明成分变化 在新近感染艾滋病毒的人群中，女性和少数族裔人口占 感染率不成比例。艾滋病毒事件中这些新兴的健康差异表明 成功的“达到零”公共卫生计划（例如，预防前预防的快速扩张[PREP]， 针头交换和安全的注射地点等）未达到最脆弱的人群。 利用常规收集的监视数据与主要数据收集配对，这是主要目标 研究是使用旧金山来确定快速城市中艾滋病毒感染的残留驱动因素 案件。该建议旨在提供多学科的方法论和理论培训，以调查 在“零”时代，持续的艾滋病毒传播的科学知识差距。拟议的培训 区域是：（1）半参数统计建模和机器学习，以提高准确性和 人口规模估计方法的精度； （2）分子流行病学和系统发育技术 评估个体之间的艾滋病毒病毒序列的相关性，推断出共享的感染来源；和 （3）衡量环境的（社会结构）特征的少数群体压力理论并将其关联 艾滋病毒感染差异的结构暴露。与培训组件保持一致，研究目标 这项研究是：（a）估计有多少人在旧金山居住并量化 感染率和获得医疗服务的分配幅度； （b）确定社会人口统计学 会员资格与传输集群的相关性； （c）确定最近艾滋病毒的社会结构促进者 使用病例对照研究设计，感染，特别是在少数群体中。产生的证据 从这项工作中，可能会直接影响旧金山的零运动并告知小说 其他快速城市的干预目标。此外，特殊的方法论和实用性 从该项目获得的经验将使候选人成为独立职业的候选人 研究员。