Geographic Variability in Time from HIV Diagnosis to Viral Suppression in the Deep South: A Roadmap to Accelerated Treatment Initiation

南方腹地从艾滋病毒诊断到病毒抑制的时间地理差异：加速治疗启动的路线图

• 批准号: 10305677
• 负责人: David S Batey
• 金额: $ 42.75万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-24 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10305677
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; Age; Alabama; Area; Automobile Driving; Caring; Case Study; Characteristics; Cities; Clinical; Code; Collaborations; Communities; Continuity of Patient Care; Country; Data; Deep South; Development; Diagnosis; Epidemic; Evaluation; Funding; Geography; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Health Resources; Health system; Heterogeneity; Individual; International; Intervention; Interview; Investigation; Louisiana; Medicaid; Methods; Mississippi; Newly Diagnosed; Outcome; Patients; Persons; Population; Poverty; Provider; Public Health; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Research Proposals; Resources; Social Work; System; Testing; Time; United States; United States National Institutes of Health; Universities; Viral; Virus Diseases; analytical tool; antiretroviral therapy; care outcomes; contextual factors; cost effective intervention; cost effectiveness; design; experience; health disparity; implementation cost; implementation trial; improved; improved outcome; informant; innovation; intervention program; novel; population health; programs; prototype; racial disparity; service providers; social stigma; socioeconomics; surveillance data; therapy development; transmission process; treatment services; underserved area

Project Abstract This proposal describes a 5-year research plan that seeks to address gaps in our understanding of the individual, geographic, and sociocontextual determinants of delays in achieving HIV viral suppression (VS) in the Deep South region of the United States (US), an area carrying a disproportionate burden of the country’s HIV epidemic. The proposal leverages a dynamic and innovative collaboration of experienced investigators from the University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR) and the HIV Divisions of the state health departments in Alabama (AL), Louisiana (LA), and Mississippi (MS). This novel research proposal utilizes a population-health approach to evaluate time to VS among newly diagnosed individuals and integrates a mixed-methods approach to examine the socioeconomic, demographic, and structural determinants of time to VS in this population in the development of an intervention to accelerate initiation of antiretroviral therapy (ART). The specific aims of this proposal are to: 1) Utilize HIV surveillance data collected by the states’ public health electronic HIV/AIDS Reporting System (eHARS) to characterize geographic variability in time from HIV diagnosis to VS (<200 c/mL) among newly reported HIV cases among those age ≥13 years at diagnosis between January 2014-December 2017 in AL, LA, and MS; 2) Identify individual and community-level determinants of time to VS, incorporating quantitative geospatial coding methods, in AL, LA, and MS among newly reported cases of HIV among those age ≥13 years at diagnosis from January 2014-December 2017 and contextualize these findings with qualitative key informant interviews among persons living with HIV (PLWH), HIV treatment and social services providers, and other community stakeholders in AL, LA, and MS; and 3) Engage stakeholders in developing a rapid ART initiation program focusing upon localities in the Deep South with disproportionately longer time from HIV diagnosis to VS. We will then incorporate these results in an R01 application testing the implementation of a community-level rapid ART initiation program in the Deep South, focusing on areas with longer time from HIV diagnosis to VS. Results of this research will lay the groundwork for a larger implementation trial that will include rigorous evaluation of interventions integrating clinical and public health systems aimed at improving time to VS in the US with consideration for cost-effectiveness.

项目摘要 该提案描述了一项为期 5 年的研究计划，旨在解决我们理解上的差距 延迟实现艾滋病毒病毒传播的个人、地理和社会背景决定因素 美国（US）南部腹地地区的压制（VS），该地区承载着 该提案利用了动态的和不成比例的艾滋病毒流行负担。 阿拉巴马大学经验丰富的研究人员的创新合作 伯明翰 (UAB) 艾滋病研究中心 (CFAR) 和州卫生部门艾滋病毒部门 阿拉巴马州 (AL)、路易斯安那州 (LA) 和密西西比州 (MS) 的部门这项新颖的研究计划。 利用人口健康方法来评估新诊断个体的 VS 时间 并整合了一种混合方法来审查社会经济、人口和 在制定干预措施时，该人群中 VS 时间的结构决定因素 加速启动抗逆转录病毒治疗（ART） 该提案的具体目标是：1) 利用各州公共卫生电子艾滋病毒/艾滋病报告收集的艾滋病毒监测数据 系统 (eHARS) 用于表征从 HIV 诊断到 VS 的时间地理变异性（<200 c/mL）在诊断时年龄≥13岁的新报告艾滋病毒病例中 2014 年 1 月至 2017 年 12 月，阿拉巴马州、洛杉矶和密苏里州 2) 确定个人和社区层面； VS 时间的决定因素，结合定量地理空间编码方法，在 AL、LA 和 自 1 月起诊断时年龄≥13 岁的新报告 HIV 病例中 MS 2014 年至 2017 年 12 月，并将这些发现与定性关键知情人访谈联系起来 艾滋病毒感染者 (PLWH)、艾滋病毒治疗和社会服务提供者以及其他 3) 让利益相关者参与快速开发 ART 启动计划重点关注南部腹地地区，且时间较长 从 HIV 诊断到 VS 的时间，我们会将这些结果纳入 R01 应用测试中。 在南部腹地实施社区级快速 ART 启动计划，重点关注 这项研究的结果将奠定从 HIV 诊断到 VS 时间较长的领域。 为更大规模的试验实施奠定基础，其中包括对干预措施的严格评估 旨在缩短美国 VS 时间的临床整合和公共卫生系统 成本效益的考虑。