The impact of health disparities and alcohol use on late diagnosis of HIV in Florida: Understanding missed opportunities using a statewide dataset

佛罗里达州健康差异和饮酒对艾滋病毒晚期诊断的影响：使用全州数据集了解错失的机会

• 批准号: 10619696
• 负责人: Christina Elizabeth Parisi
• 金额: $ 4.19万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-16 至 2025-05-15
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619696
• 关键词: Address; Affect; Alcohol consumption; Alcohols; Area; Award; Behavioral; CD4 Lymphocyte Count; Caring; Cells; Characteristics; Clinical; Collection; Communicable Diseases; Communities; Consensus; Data; Data Set; Diagnosis; Dimensions; Disease Progression; Disparity; Epidemic; Epidemiologic Methods; Epidemiologist; Fellowship; Florida; Foundations; Goals; Guidelines; HIV; HIV diagnosis; HIV/AIDS; Health; Healthcare; Heavy Drinking; Human immunodeficiency virus test; Incidence; Individual; Infection; Intervention; Interview; Lead; Learning; Link; Literature; Manuscripts; Measures; Medical; Mentors; Methods; Modeling; Modification; Monitor; Morbidity - disease rate; National Institute on Alcohol Abuse and Alcoholism; National Research Service Awards; Outcome; Participant; Pattern; Persons; Phase; Policies; Population; Population Surveillance; Postdoctoral Fellow; Production; Public Health; Registries; Reporting; Research; Research Activity; Risk; Science; Scientist; Statistical Methods; Strategic Planning; Structure; Surveys; System; Testing; Training; Training Activity; United States; Viral Load result; Viremia; access disparities; alcohol effect; alcohol research; career; clinically significant; epidemiology study; health care availability; health data; health disparity; high risk; improved; interdisciplinary approach; longitudinal analysis; mortality; pre-doctoral; psychosocial; recruit; skills; social; social factors; structural determinants; substance use; transmission process

Project Summary/Abstract Late diagnosis of HIV is a significant public health problem due to increased risk for morbidity and mortality and the potential for HIV transmission. This Kirschstein NRSA Predoctoral Fellowship (PA-21-051) proposal aims to conduct an interdisciplinary multiphase explanatory sequential mixed-methods study to better understand the social-ecological factors associated with late HIV diagnosis, examine longitudinal HIV health outcomes (e.g., CD4 count and viremia), identify facilitators/barriers to HIV testing and healthcare engagement, and understand the impact of alcohol. This proposal responds to the National HIV/AIDS Strategy to identify missed opportunities for diagnosis, the Ending the HIV Epidemic Initiative to reduce late diagnosis, and the National Institute on Alcohol Abuse and Alcoholism (NIAAA)’s Strategic Plan to understand how alcohol affects HIV disease progression. Recent literature investigating factors associated with late is limited in United States populations. Moreover, there is not a consensus on the clinical definition of late diagnosis; common definitions are “traditional” CD4 count<200 cells/mm3 and “expanded” CD4 from 200 cells/mm3 up to 350 cells/mm3, though no studies to date have compared these definitions by significant covariates or longitudinal outcomes. The effect of alcohol is also understudied despite known associations with worse health and care engagement. To achieve the goals of this study, we will link two statewide datasets of people with HIV (PWH) in Florida: Medical Monitoring Project (MMP) and Enhanced HIV/AIDS Reporting System (eHARS) data collected between 2015-and 2019 (N=2,000). First, we will determine the incidence and describe demographic, behavioral, and psychosocial disparities between those with and without multiple definitions (traditional vs expanded) of late HIV diagnosis. Second, we will create generalized linear mixed effect models to compare longitudinal outcomes by late diagnosis and assess potential effect modification of heavy alcohol; we will use a subset of this data including only those diagnosed between 2015-and 2019 (N=200). Finally, we will explore reasons for late diagnosis, identify missed opportunities for testing, and determine new intervention points through qualitative interviews with 20-25 PWH with late HIV diagnosis in the Southern HIV and Alcohol Research Consortium (SHARC) contact registry (N=750). Findings will inform intervention and policy targets to reduce late diagnosis by identifying health disparities and missed opportunities for testing and healthcare engagement. A benefit of this award is training to establish the foundation of a successful career in epidemiologic research and intervention science such as 1) learning strengths, limitations, and implications of using multidimensional public health data to measure substance use and health outcomes; (2) understand the rationale for using different statistical methods to answer longitudinal research questions with public health data; and (3) leading collection and analysis of qualitative data as part of a mixed-methods study, in addition to developing skills such as manuscript production and giving presentations.

项目摘要/摘要 艾滋病毒的晚期诊断是一个重大的公共卫生问题，由于发病率和死亡率的风险增加以及 HIV传播的潜力。这个Kirschstein NRSA前奖学金（PA-21-051）提案的目标 进行跨学科的多相挖掘顺序混合方法研究以更好地理解 与晚期HIV诊断有关的社会生态因素，检查纵向HIV健康结果 （例如，CD4计数和病毒血症），确定艾滋病毒测试和医疗保健参与的促进者/障碍，以及 了解酒精的影响。该提案对国家艾滋病毒/艾滋病战略做出了回应，以确定错过 诊断的机会，结束艾滋病毒流行倡议以减少晚期诊断的措施以及国家 酒精滥用和酒精中毒研究所（NIAAA）的战略计划，了解酒精如何影响艾滋病毒 疾病进展。在美国，最近调查与晚期相关因素的文献调查因素有限 人群。此外，关于晚期诊断的临床定义尚无共识。常见定义 “传统” CD4计数<200个单元/mm3和“扩展” CD4从200个/mm3到350个单元/mm3， 尽管迄今为止尚未通过重要的协变量或纵向结局进行比较。 酒精的影响也被理解为已知的任务协会，健康和护理参与度较差。 为了实现这项研究的目标，我们将在佛罗里达州链接两个全州艾滋病毒（PWH）患者的数据集： 收集的医疗监测项目（MMP）和增强的艾滋病毒/艾滋病报告系统（EHARS）数据 在2015年至2019年之间（n = 2,000）。首先，我们将确定事件并描述人群， 有和没有多个定义的人之间的行为和社会心理差异（传统与 扩展）晚期HIV诊断。其次，我们将创建广义的线性混合效应模型来比较 纵向诊断和评估潜在效果的纵向结局；我们将使用一个 这些数据的子集，包括仅在2015年至2019年之间诊断的数据（n = 200）。最后，我们将探索 延迟诊断的原因，确定未进行测试的机会并确定新的干预点 通过与20-25 PWH的定性访谈以及南部艾滋病毒和酒精的HIV晚期诊断 研究财团（Sharc）联系人注册表（n = 750）。调查结果将为干预和政策目标提供信息 通过识别健康分配和错过测试和医疗保健的机会来减少晚期诊断 订婚。该奖项的好处是培训以建立成功职业的基础 流行病学研究和干预科学，例如1）学习优势，局限性和影响 使用多维公共卫生数据来衡量物质使用和健康结果； （2）了解 使用不同的统计方法回答公共卫生的纵向研究问题的理由 数据; （3）作为混合方法研究的一部分，领先的定性数据收集和分析 开发诸如手稿制作和介绍之类的技能。