Understanding Health Inequities at the Intersection of the HIV and substance use epidemics across racial/ethnic and other underserved populations

了解不同种族/族裔和其他服务不足人群中艾滋病毒和药物滥用流行病交汇处的健康不平等

• 批准号: 10738418
• 负责人: Heidi M. Crane
• 金额: $ 73.89万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738418
• 关键词: Abbreviations; Acquired Immunodeficiency Syndrome; Address; Affect; Aging; Alcohol consumption; Alcohols; Area; Behavior; Behavioral; Black, Indigenous, People of Color; Cannabis; Caring; Chronic Kidney Failure; Clinical; Clinical Data; Cocaine; Cocaine Users; Collaborations; Communities; Continuity of Patient Care; Critical Thinking; Data; Diabetes Mellitus; Dimensions; Discrimination; Disparity; Drug usage; Epidemic; Equity; Ethnic Origin; Ethnic Population; Evaluation; Frequencies; Future; Gender; Gender Identity; General Population; Goals; HIV; Health Services Accessibility; High Prevalence; Hispanic; Housing; Hypertension; Imprisonment; Individual; Inequity; Infrastructure; Intersex; Intervention; Knowledge; Latinx; Lesbian Gay Bisexual Transgender Queer Questioning; Measures; Mental Health; Methamphetamine; Myocardial Infarction; Naloxone; Nicotine; Opioid; Outcome; Outcome Assessment; Overdose; Patient Outcomes Assessments; Pattern; Persons; Pharmaceutical Preparations; PhenX Toolkit; Population; Population Heterogeneity; Poverty; Prevention; Prevention approach; Psychosocial Factor; Race; Recommendation; Research; Resources; Risk Behaviors; Risk Factors; Role; Severities; Sex Orientation; Social support; Stimulant; Stroke; Substance Use Disorder; System; Time; Treatment outcome; Underserved Population; United States; Viral; Work; adjudication; adverse childhood events; age related; asexual; cocaine use; cohort; community partnership; comorbidity; disparity reduction; ethnic identity; experience; frailty; health disparity; health inequalities; health related quality of life; housing instability; illicit opioid; indexing; insight; instrument; intimate partner violence; marginalized population; medication compliance; methamphetamine use; multiple drug use; opioid epidemic; opioid use; outcome disparities; overdose death; overdose risk; perceived discrimination; protective factors; psychosocial; racial difference; racial population; social; social factors; social health determinants; social stigma; social structure; sociodemographics; spelling; structural determinants; substance use; substance use prevention; substance use treatment; transgender; treatment and outcome; treatment program; treatment response; treatment strategy; uptake; Abbreviations; Acquired Immunodeficiency Syndrome; Address; Affect; Aging; Alcohol consumption; Alcohols; Area; Behavior; Behavioral; Black, Indigenous, People of Color; Cannabis; Caring; Chronic Kidney Failure; Clinical; Clinical Data; Cocaine; Cocaine Users; Collaborations; Communities; Continuity of Patient Care; Critical Thinking; Data; Diabetes Mellitus; Dimensions; Discrimination; Disparity; Drug usage; Epidemic; Equity; Ethnic Origin; Ethnic Population; Evaluation; Frequencies; Future; Gender; Gender Identity; General Population; Goals; HIV; Health Services Accessibility; High Prevalence; Hispanic; Housing; Hypertension; Imprisonment; Individual; Inequity; Infrastructure; Intersex; Intervention; Knowledge; Latinx; Lesbian Gay Bisexual Transgender Queer Questioning; Measures; Mental Health; Methamphetamine; Myocardial Infarction; Naloxone; Nicotine; Opioid; Outcome; Outcome Assessment; Overdose; Patient Outcomes Assessments; Pattern; Persons; Pharmaceutical Preparations; PhenX Toolkit; Population; Population Heterogeneity; Poverty; Prevention; Prevention approach; Psychosocial Factor; Race; Recommendation; Research; Resources; Risk Behaviors; Risk Factors; Role; Severities; Sex Orientation; Social support; Stimulant; Stroke; Substance Use Disorder; System; Time; Treatment outcome; Underserved Population; United States; Viral; Work; adjudication; adverse childhood events; age related; asexual; cocaine use; cohort; community partnership; comorbidity; disparity reduction; ethnic identity; experience; frailty; health disparity; health inequalities; health related quality of life; housing instability; illicit opioid; indexing; insight; instrument; intimate partner violence; marginalized population; medication compliance; methamphetamine use; multiple drug use; opioid epidemic; opioid use; outcome disparities; overdose death; overdose risk; perceived discrimination; protective factors; psychosocial; racial difference; racial population; social; social factors; social health determinants; social stigma; social structure; sociodemographics; spelling; structural determinants; substance use; substance use prevention; substance use treatment; transgender; treatment and outcome; treatment program; treatment response; treatment strategy; uptake

People with HIV (PWH) in underserved racial/ethnic and marginalized populations (UREMP) carry a disproportionate burden of health disparities related to substance use and HIV. The goal of this study is to elucidate and address disparities experienced by UREMP in substance use patterns, substance use treatment outcomes and HIV-related outcomes including the contribution of social, cultural, structural, and other factors. We focus on underserved racial/ethnic populations as well as other marginalized groups such as those who are transgender, have unstable housing, or were recently incarcerated. We will 1. Determine methamphetamine, cocaine and opioid-related behaviors, risk factors, and treatment outcomes to better understand health disparities among UREMP and better tailor future intervention/treatment and prevention approaches. We will examine differences in drug-related behaviors including types, frequency, severity of use, mode of administration, polydrug use, overdoses, Naloxone access, and substance use treatment access and outcomes. We will determine the role of demographic, behavioral, psychosocial and clinical factors, and incorporate additional structural/social measures such as of racial/ethnic identity, stigma/discrimination, and other domains based on recommendations from community partners, end-users, and critical thought partners to determine risk factors for differences in drug use patterns and substance use treatment outcomes. 2. Determine the role of methamphetamine, cocaine and opioid use in HIV-related outcome disparities among UREMP. We will examine longitudinal relationships between drug use, social, cultural, and structural factors, and HIV care cascade steps such as engagement in care, viral suppression and health-related quality of life. We will determine the impact of drug use and social, structural, and other factors on age-related comorbidities, such as diabetes, frailty, myocardial infarction and chronic kidney disease among UREMP. We leverage the large well-characterized racially/ethnically, gender, and sexual orientation-diverse cohort of PWH with comprehensive clinical data in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. The CNICS patient reported outcomes assessment captures detailed drug use patterns, psychosocial, behavioral and other factors such as social support and racial stigma/discrimination and facilitates capturing multiple dimensions of identity. CNICS geocoding and carefully adjudicated outcomes facilitates including structural factors and evaluation of HIV-related comorbidities. CNICS data and our team bring a breadth and depth of resources, responding to RFA-DA-23-061 by generating new knowledge about substance use-related disparities among PWH from UREMP and the impact of social, structural, and cultural factors. This study will inform future research and assist end-users within our community partnerships in tailoring future substance use treatment programs to the unique needs associated with people’s multidimensional identities in order to reduce disparities among populations affected by inequities at the intersection of HIV care and substance use.

在服务不足的种族/种族和边缘化人群（Uremp）中患有艾滋病毒（PWH）的人（uremp） 与药物使用和艾滋病毒有关的健康差异的伯恩伯恩不成比例。这项研究的目的是 Uremp在药物使用模式中阐明和解决分布，物质使用治疗 结果和与HIV相关的结果，包括社会，文化，结构和其他因素的贡献。 我们专注于服务不足的种族/民族人口以及其他边缘化群体，例如 是跨性别者，有不稳定的住房或最近继承。我们将1。确定 甲基苯丙胺，可卡因和与OIOID相关的行为，危险因素和治疗结果以更好 了解Uremp之间的健康分布，并更好地量身定制未来的干预/治疗和预防 方法。我们将研究与药物相关行为的差异，包括类型，频率，使用的严重程度， 给药方式，多药用使用，过量服用，纳洛酮的访问和物质使用治疗访问和 结果。我们将确定人口，行为，社会心理和临床因素的作用，以及 纳入其他结构/社会措施，例如种族/种族身份，污名/歧视和 根据社区合作伙伴，最终用户和批判思想伙伴的建议，其他领域 确定药物使用模式差异和药物使用治疗结果的危险因素。 2。 确定甲基苯丙胺，可卡因和OOid在与HIV相关的结果分布中的作用 Uremp。我们将研究吸毒，社会，文化和结构性因素之间的纵向关系， 以及艾滋病毒护理级联步骤，例如参与护理，病毒抑制和与健康相关的生活质量。 我们将确定吸毒以及社会，结构和其他因素对与年龄相关的合并症的影响， 例如糖尿病，脆弱，心肌梗塞和慢性肾脏疾病。我们利用 与种族/种族，性别和性取向多样性多样性的PWH相同的大型特征良好的种族/种族性，性别和性取向 艾滋病综合临床系统研究网络（CNICS）的综合临床数据 队列。 CNICS患者报告的结果评估捕获了详细的药物使用模式，心理社会， 行为和其他因素，例如社会支持和种族污名/歧视，并促进捕获 身份的多个维度。 CNICS地理编码和仔细调整的结果宿主包括 结构性因素和与HIV相关的合并症的评估。 CNIC数据和我们的团队带来了广度和 资源深度，通过产生有关物质使用相关的新知识来回应RFA-DA-23-061 PWH与Uremp的差异以及社会，结构和文化因素的影响。这项研究会 为未来的研究提供信息，并协助我们社区合作伙伴关系的最终用户来调整未来的主题 使用治疗计划来满足与人们的多维身份相关的独特需求 减少在艾滋病毒护理和药物使用交集时受到不平等影响的人群之间的分布。