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.

项目概要 个人、网络、社区和结构层面变量的组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) 等南部腹地州， 他们不成比例地承担着国家的艾滋病毒负担，同时拥有最少的医疗资源。 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， 特别是那些基于数字的，已经从多层次的角度检查了 VS，该镜头解释了 与南方腹地密切相关的地理和社区层面的特征，例如总体贫困 措施、种族隔离和医疗保健获取通常也排除了患有这种疾病的人。 具有非持续 VS（非 VS）或最近没有 HIV 实验室的 HIV (PWH)，因为这些是最难检测的 由于他们的医疗保健参与有限，我们经验丰富的研究团队将解决这一问题。 通过拟议的 UG3-UH3 研究弥补这些研究空白，该研究将利用移动医疗技术来优化 在阿拉巴马州、洛杉矶和多发性硬化症患者中招募、筛选、登记和保留 1000 名非 VS 或 MS 患者的前瞻性数字队列 缺乏过去 12 个月接受护理的证据，利用长期存在的证据 与这三个州的公共卫生部门的关系我们将组建一个社区。 咨询委员会 (CAB)，由 PWH、卫生部门合作伙伴和三个地区的艾滋病毒护理团队成员组成 状态，我们将使用信息系统研究（ISR）框架来定制现有的功能 PWH 管理应用程序 WiseApp 我们将测试 Drive to Zero 应用程序原型的可用性。 符合资格的队列参与者将是年龄 ≥ 18 岁、居住在阿拉巴马州、洛杉矶或密苏里州的 PWH。 感染艾滋病毒≥12个月，并进入增强型艾滋病毒/艾滋病报告系统（eHARS），这是一个标准化的 所有州卫生部门使用基于文件的监测数据库来报告诊断和结果， 记录的 VL≥200 c/mL ≤12 个月或在同一时期内缺少 HIV 实验室值的参与者。 将在三年内进行迭代年度心理社会定量调查评估 通过 Drive to Zero 应用程序来评估非 VS 的预测因子、中介因子和调节因子。 通过使用地理空间分析来获取定量数据，将参与者注册时的居住地址与 人口普查数据的数字队列参与者 (n=45) 也将有资格参与定性深入研究。 这项研究的结果将为招募大规模的人员提供信息。 PWH 的数字队列，并将成为首批展示保留数字队列的有效方法的人之一 研究结果也将有助于确定导致艾滋病毒和其他健康状况的多层次因素。 南方腹地的非VS，从而阐明未来的干预领域，并将直接导致后续的 向上R级应用程序。