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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要城市占全球艾滋病毒感染者人口的很大一部分。因此，城市已成为艾滋病毒感染者。成为联合国艾滋病规划署“快速通道”方法的重点，通过有针对性的扩大规模来结束艾滋病流行在美国，艾滋病毒监测数据表明预防和检测服务的构成正在发生变化。新感染艾滋病毒的人口中，女性和少数民族人口占这些新出现的艾滋病毒感染率健康差异表明，很大程度上成功的“实现零”公共卫生举措（例如快速扩大暴露前预防[PrEP]，针头交换和安全注射地点等）尚未惠及最弱势群体。利用常规收集的监测数据与主要数据收集相结合，这是该项目的主要目标研究旨在以旧金山为样本，确定快速通道城市中艾滋病毒感染的残留驱动因素该提案旨在提供多学科方法和理论培训来调查该案例。 “走向零”时代持续艾滋病毒传播的科学知识差距。领域包括：（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准确性；（2）分子流行病学和系统发育技术评估个体之间 HIV 病毒序列的相关性，推断共同的感染源； (3) 少数民族压力理论，用于衡量环境的（社会结构）特征并将这些特征联系起来艾滋病毒感染差异的结构性暴露与培训内容、研究目标相一致。这项研究的目的是： (a) 估计旧金山有多少人感染艾滋病毒并量化 (b) 确定社会人口统计成员与传播集群的相关性；以及 (c) 确定近期艾滋病毒的社会结构促进因素使用病例对照研究设计产生的证据来控制感染，特别是少数群体中的感染。这项工作可能会对旧金山的“零排放”运动产生直接影响，并为小说提供信息此外，其他快速通道城市的干预目标也具有出色的方法和实践。从该项目中获得的经验将使候选人能够以独立的身份从事有影响力的职业生涯研究员。