Activity spaces for HIV risk and prevention among diverse men who have sex with men in Los Angeles

洛杉矶不同男男性行为者的艾滋病毒风险和预防活动空间

基本信息

批准号：
10081422
负责人：
SUSAN LYNN CASSELS
金额：
$ 22.06万
依托单位：
UNIVERSITY OF CALIFORNIA SANTA BARBARA
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：
2020-07-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10081422
关键词：
AIDS prevention Address African American Alcohol or Other Drugs use Area Behavior Behavioral Caring Censuses Characteristics County Data Decision Making Diagnosis Drug usage Effectiveness Effectiveness of Interventions Epidemic Exposure to Geography Goals HIV HIV diagnosis HIV risk Home environment Incidence Individual Infection Intervention Investments Link Location Logistic Regressions Los Angeles Low Prevalence Measures Methods Modeling Neighborhoods Online Systems Physical environment Policies Population Prevention Race Residential Mobility Risk Role Sampling Sexual Health Social Environment Surveys Time United States Update Viral Load result Work aged base black men who have sex with men burden of illness cognitive interview cohort data space drug use behavior geographic risk health disparity health seeking behavior high risk improved innovation men men who have sex with men metropolitan pre-exposure prophylaxis preference racial and ethnic racial minority response sex social space sociodemographics transmission process treatment strategy

项目摘要

Abstract One of the key strategies to ending the HIV epidemic in the United States is to increase investments in geographic hotspots, or areas of elevated disease burden. However, a few key challenges limit the ability for hotspot mapping to inform effective HIV interventions. First, hotspot mapping typically uses residential address of an individual with an incident infection. Yet for many individuals, potential risky sex and drug-use behaviors do not occur at home. Identifying the places in which risk occurs, as opposed to where an individual who engages in risk lives, will help target and increase exposure to place-based interventions. Second, individual behavior is often constrained or dictated by larger socio-ecological factors, and these can work together to create or maintain health disparities. Interventions tailored to risk hotspots to improve the HIV care cascade need to be responsive to the broader socio-ecological context of the hotspot. Third, an implicit assumption about prioritizing hotspots for interventions is that efforts to reduce incidence in hotspots will indirectly reduce incidence elsewhere as well, as infections likely spread from high incidence areas to neighboring lower prevalence areas. Information on potential geographic and sexual network connectivity between hotspots and other places can inform prioritization of risk hotspots for HIV interventions. We will demonstrate innovative methods to identify and prioritize HIV risk hotspots among urban, non-white men who have sex with men (MSM), populations at especially high-risk for HIV in the United States. We will leverage and supplement existing longitudinal data on non-White MSM, both HIV-infected and uninfected, from the ongoing mStudy cohort in Los Angeles, to achieve our goals. We will first adapt an existing web-based activity space survey of HIV risk and prevention to incorporate geographic characteristics of networks, residential mobility, and locations of drug use. Then we will use cognitive interviews to validate the survey instrument, and collect data from 250 MSM using the updated survey. Second, we will identify and describe HIV transmission and acquisition risk hotspots within Los Angeles County, using individual activity space data on sexual risk and drug use locations, neighborhood characteristics of the hotspots, and sociodemographic characteristics and behaviors of individuals engaging in risk in the hotspots. Third, we will estimate connectivity of hotspots to other locations (e.g., other hotspots, residential locations, and prevention locations), in order to identify which hotspot to prioritize for maximizing intervention effectiveness over time and space. This work will improve the effectiveness of HIV prevention, care, and treatment strategies in two ways. First, it will guide decision making as to which hotspot to prioritize, by ranking them in terms of potential connectivity to other places, and thus maximizing the reach of the intervention. Second, it will inform which combination of interventions will be most successful, by characterizing the context and composition of the hotspot.

抽象的结束美国艾滋病毒流行的关键策略之一是增加对地理热点或疾病负担增加的地区。但是，一些关键挑战限制了热点映射以告知有效的HIV干预措施。首先，热点映射通常使用住宅地址患有事件感染的人。然而，对于许多人来说，潜在的风险性行为和毒品使用行为不在家里。确定风险发生的地方，而不是一个人从事风险生命，将有助于目标并增加对基于地点的干预措施的接触。第二，个人行为通常受到更大的社会生态因素的限制或决定，这些行为可以共同起作用建立或维持健康差异。针对风险热点量身定制的干预措施，以改善艾滋病毒护理级联需要对热点的更广泛的社会生态环境做出反应。第三，隐含的假设关于优先考虑干预措施的热点是降低热点发病率的努力将间接减少其他地方的发病率也很可能从高发地区传播到邻近的下部患病率区域。有关热点与潜在地理和性网络连通性的信息其他地方可以为HIV干预措施的风险热点提供优先级。我们将展示创新的方法来识别和确定城市，非白人的艾滋病毒风险热点与男性发生性关系的男性（MSM），在美国特别高风险的人口。我们将从艾滋病毒感染和未感染的非白人MSM上的现有纵向数据的杠杆和补充洛杉矶正在进行的MSTUDY队列，以实现我们的目标。我们将首先调整现有的基于Web的现有艾滋病毒风险和预防的活动空间调查，以纳入网络的地理特征，住宅流动性和吸毒的位置。然后，我们将使用认知访谈来验证调查仪器，并使用更新的调查从250 msm收集数据。其次，我们将识别并描述使用个人活动空间数据，洛杉矶县内的HIV传播和获取风险热点关于性风险和吸毒位置，热点的邻居特征和社会人口统计学个人在热点中冒险的人的特征和行为。第三，我们将估计热点与其他位置的连通性（例如其他热点，住宅位置和预防位置），为了确定哪个热点要优先考虑，以最大程度地提高干预效果。这项工作将通过两种方式提高预防艾滋病毒，护理和治疗策略的有效性。首先，它将通过潜在的连通性对哪种热点进行优先级的决策来指导决策其他地方，从而最大程度地提高干预措施。其次，它将告知哪种组合通过表征热点的上下文和组成，干预措施将是最成功的。