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

基本信息

批准号：
10231180
负责人：
Kathleen Ann McManus
金额：
$ 19.25万
依托单位：
UNIVERSITY OF VIRGINIA
依托单位国家：
美国
项目类别：
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/10231180
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 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

项目摘要

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.

项目概要/摘要 K08 指导职业发展奖的总体目标是支持 Kathleen A. McManus 博士职业生涯的开始，为她提供了足够的时间将她的研究集中在交叉领域的关键问题上流行病学、艾滋病毒健康结果和卫生政策。她的职业发展计划将利用她的背景研究三个目标：1）掌握定量流行病学的技能（设计、分析和解释）研究; 2) 获得将这些分析应用于州和联邦卫生政策的专业知识；和 3) 独立。她的 K08 研究的首要目标是解构 HIV 病毒抑制差异。具体来说，她将对多州（弗吉尼亚州和南卡罗来纳州）数据进行二次分析，以 1) 确定与艾滋病药物援助失访相关的人口和医疗保健系统层面的因素计划 (ADAP) 客户端； 2) 估计平价医疗法案 (ACA) 合格健康计划状态对持续抑制个体 HIV 病毒并评估 ADAP 客户之间结果的差异；和 3) 量化可修改的医疗保健提供因素作为影响因素的州/人口水平影响 ADAP 客户之间的病毒抑制因种族/民族而存在差异。 HIV病毒抑制是一个关键成果。它有利于个人和社区的寿命，因为它与新病例的减少有关艾滋病毒感染。这项研究将为缩小 ADAP 服务的低收入 PLWH 的政策提供依据。在为了监测实现艾滋病毒目标的进展，各州需要准确、及时的数据。如果失去后续导致数据并非完全随机丢失，这可能会导致数据有偏差和政策次优。了解影响失访的因素将有助于 ADAP 确定干预措施的优先群体和将允许调整未来分析的选择偏差。研究这个多状态 ADAP 队列的 ACA 经验适用于全国约 225,000 名 ADAP 客户。如果 ACA 被更改或废除，或者如果弗吉尼亚州或南卡罗来纳州扩大医疗补助计划后，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其他州和联邦层面的分析。它履行了美国国家法律的主要组成部分艾滋病毒/艾滋病战略，通过确定加强及时提供和使用高质量数据和通过描述可改变的因素对可作为干预目标的差异的影响。这个提议受益于由领先研究人员组成的强大咨询团队，他们在流行病学、随意推理、计量经济学、健康结果、卫生政策和艾滋病毒结果。从指导、合作中汲取灵感，传染病和公共卫生科学部门以及弗吉尼亚州合作伙伴的支持和南卡罗来纳州一样，弗吉尼亚大学是获得该奖项的理想机构，其长期目标是博士。麦克马纳斯将成为一名独立的临床医生研究员，专注于改善人们的健康结果通过优化数据收集和分析以及将数据转化为政策和行动来应对艾滋病毒感染者。