Drive to Zero: Developing a digital cohort to understand the drivers of non-sustained viral suppression in the Deep South

驱向零：开发数字队列以了解南方腹地非持续病毒抑制的驱动因素

• 批准号: 10675270
• 负责人: David S Batey
• 金额: $ 127.31万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675270
• 关键词: 18 year old; Address; Adherence; Age; Alabama; Area; Automobile Driving; Caring; Case Study; Censuses; Centers for Disease Control and Prevention (U.S.); Characteristics; Collaborations; Communities; Continuity of Patient Care; Country; Data; Data Collection; Data Reporting; Databases; Deep South; Dependence; Diagnosis; Elements; Eligibility Determination; Enrollment; Epidemic; Epidemiology; Exclusion; Feedback; Foundations; Funding; Future; Geography; Goals; HIV; HIV diagnosis; HIV/AIDS; Health; Health behavior; Healthcare; Heterogeneity; Incidence; Individual; Inequality; Inequity; Infection; Information Systems; Insurance; Intervention; Interview; Laws; Link; Louisiana; Low income; Measures; Mediator; Methods; Mississippi; Mobile Health Application; Modeling; Morbidity - disease rate; Newly Diagnosed; Outcome; Participant; Persons; Policies; Poverty; Public Health; Qualitative Methods; Racial Segregation; Rana; Reporting; Research; Resources; Role; Sampling; Self Management; Social Work; Standardization; Surveys; System; Technology; Testing; Time; U-Series Cooperative Agreements; United States; Viral; Viral Load result; Work; antiretroviral therapy; cohort; community based participatory research; cost; digital; epidemiology study; ethnic minority population; evidence base; experience; follow-up; health care availability; health management; improved; improved outcome; lens; mHealth; member; mortality; population health; primary outcome; prospective; prototype; psychosocial; racial minority population; recruit; residence; response; service providers; social; social stigma; social structure; structural determinants; surveillance data; systems research; therapy adherence; therapy development; transmission process; treatment services; trend; usability

PROJECT SUMMARY A combination of individual-, network-, community-, and structural-level variables impact all steps in the HIV Care Continuum, particularly in the Deep South states of Alabama (AL), Louisiana (LA), and Mississippi (MS), which disproportionately bear the nation's HIV burden while simultaneously having the fewest healthcare resources. While the individual-level correlates of viral suppression (VS) are well-known, few epidemiologic studies, especially those that are digitally-based, have examined VS from a multilevel lens that accounts for the role of geographic and community-level characteristics germane to the Deep South, such as aggregate poverty measures, racial segregation, and healthcare access. Epidemiological studies also typically exclude people with HIV (PWH) with non-sustained VS (non-VS) or without recent HIV labs, as these are among the hardest to identify and reach due to their limited healthcare involvement. Our highly experienced study team will address these research gaps through the proposed UG3-UH3 study, which will use mHealth technology to optimally recruit, screen, enroll, and retain a prospective digital cohort of 1000 PWH in AL, LA, and MS with non-VS or who otherwise lack evidence of having been in care for the previous 12 months, leveraging long-standing relationships with public health departments in each of these three states. We will assemble a community advisory board (CAB), consisting of PWH, health department partners, and HIV care team members in the three states and we will use the Information System Research (ISR) Framework to tailor features of an existing adherence management app for PWH, WiseApp. We will test usability of the Drive to Zero app prototype with PWH and informaticians. Eligible cohort participants will be PWH ages ≥18 years, living in AL, LA, or MS, living with HIV for ≥12 months, and entered in the Enhanced HIV/AIDS Reporting System (eHARS), a standardized document-based surveillance database used by all state health departments to report diagnosis and outcomes, with a recorded VL≥200 c/mL ≤12 months or have missing HIV lab values during that same period. Participants will be followed for three years with iterative annual psychosocial quantitative survey assessments conducted via the Drive to Zero app to assess predictors, mediators, and moderators for non-VS. We will contextualize quantitative data by using geospatial analysis, linking participant residence addresses at time of enrollment to Census tract data. Participants of the digital cohort (n=45) will also be eligible to participate in qualitative in-depth interviews to contextualize quantitative results. The findings from this study will inform efforts to recruit large, digital cohorts of PWH and will be among the first to demonstrate effective methods of retaining digital cohorts for HIV as well as other health conditions. Study findings will also help identify multilevel factors that contribute to non-VS in the Deep South, thereby elucidating future areas for intervention, and will directly lead to a follow- up R-level application.

项目摘要 个人，网络，社区和结构性变量的结合影响艾滋病毒护理的所有步骤 连续体，特别是在阿拉巴马州（AL），路易斯安那州（LA）和密西西比州（MS）的深处 不成比例地承受美国的艾滋病毒燃烧，同时拥有最少的医疗保健资源。 虽然病毒抑制（VS）的个体水平相关性是众所周知的，但流行病学研究很少，但 特别是基于数字的人，已经检查了从多级镜头中研究的VS，该镜头说明了 深南部的地理和社区层面特征，例如总贫困 措施，种族隔离和医疗保健获得。流行病学研究通常还排除了 艾滋病毒（PWH）具有非维持的VS（非VS）或没有最近的HIV实验室，因为这些是最难的 由于医疗保健的参与度有限，因此确定并达到障碍。我们经验丰富的学习团队将解决 这些研究差距通过拟议的UG3-UH3研究，该研究将使用MHealth技术来最佳 招募，屏幕，注册并保留了AL，LA和MS的1000 PWH的预期数字队列，并使用非VS或MS 否则他们缺乏过去12个月一直在照顾的证据，利用了长期的 与这三个州中每个州的公共卫生部门的关系。我们将组建一个社区 顾问委员会（CAB），由PWH，卫生部门合作伙伴和艾滋病毒护理团队成员组成 各州，我们将使用信息系统研究（ISR）框架来量身定制现有的功能 PWH，WISEAPP的依从性管理应用。我们将通过 PWH和信息丰富的IAN。合格的队列参与者将为PWH年龄≥18岁，居住在AL，LA或MS，生活 HIV≥12个月，进入增强的HIV/AIDS报告系统（EHARS），这是一个标准化 所有州卫生部门都使用基于文件的监视数据库报告诊断和结果， 记录的VL≥200c/ml≤12个月，或者在同一时期错过了HIV实验室值。参与者 进行三年的迭代年度心理定量调查评估 通过“驱动器”零应用程序来评估非VS的预测变量，调解器和主持人。我们将在上下文化 通过使用地理空间分析的定量数据，将参与者在注册时的居住地址联系起来 人口普查数据。数字队列的参与者（n = 45）也将有资格参与定性的深入参与 访谈以将定量结果与上下文相关。这项研究的发现将为招募大型， PWH的数字队列将是最早展示保留数字队列的有效方法的人之一 用于艾滋病毒以及其他健康状况。研究发现还将有助于确定贡献贡献的多层次因素 向南方深处的非VS，从而阐明了未来的干预领域，并将直接导致后续 UP R级应用程序。