Assessing the Impact of COVID-19-Related Distancing and Clinical Service Disruptions on the HIV Epidemic in the United States

评估与 COVID-19 相关的隔离和临床服务中断对美国艾滋病毒流行的影响

基本信息

批准号：
10618257
负责人：
Laura M Mann
金额：
$ 4.77万
依托单位：
EMORY UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-05-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10618257
关键词：
AIDS prevention Address Affect American Area Behavior Behavioral Bisexual Black Populations COVID-19 COVID-19 impact COVID-19 pandemic Caring Clinical Clinical Services Communicable Diseases Complex Data Demographic Factors Development Disparity Economics Epidemic Epidemiologic Methods Epidemiologist Epidemiology Ethnic Population Funding Gays Goals HIV HIV Infections HIV diagnosis HIV risk HIV-2 Home Incidence Infection Intervention Knowledge Longitudinal Studies Measures Medical Mentors Modeling Monitor Morphologic artifacts Network-based Pattern Persons Population Prevalence Prevention Prevention program Prevention strategy Public Health Reporting Research Research Personnel Safe Sex Science Services Sex Behavior Shapes Signal Transduction Social Distance Socialization Southeastern United States Statistical Models Target Populations Technical Expertise Training Training Programs United States United States National Institutes of Health Variant Viral Load result access disparities antiretroviral therapy behavior change care systems clinical care coronavirus disease experience future pandemic high risk infectious disease model mathematical model men who have sex with men multidisciplinary pandemic disease pandemic preparedness pre-exposure prophylaxis preventive intervention programs racial population remote intervention screening service utilization sexual risk behavior skills social telehealth tool transmission process treatment program treatment strategy

项目摘要

PROJECT SUMMARY With over 1.2 million Americans currently living with Human Immunodeficiency Virus (HIV), and nearly 40,000 new infections every year, HIV remains a major public health challenge in the United States. HIV risk is not uniform across the US population: approximately 70% of infections occur among gay, bisexual, and other men who have sex with men (MSM), and certain racial/ethnic groups experience higher HIV risk. HIV transmission remains high despite recent advancements in biomedical prevention and treatment partly because of disparities in access to these measures. Economic and social disruptions from the COVID-19 global pandemic have exacerbated these disparities and created new challenges in HIV control, disrupting access to HIV prevention and clinical care services and prompting major behavioral changes (including reductions in sexual activity, “sexual distancing”). These changes may dramatically impact the trajectory of the US HIV epidemic. There have been reports of decreased HIV diagnoses during the pandemic, but these estimates may be an artifact of reduced screening rather than decreased transmission and are therefore unreliable. Enumerating HIV transmission is critical for the provision of HIV prevention interventions; a better understanding of how the COVID-19 pandemic has affected and will continue to affect HIV dynamics of US MSM is urgently required. Increased transmission due to service disruptions may be offset by sexual distancing, but this depends on the temporal patterns and demographic distribution of these changes. Transmission may also be mitigated by interventions that address clinical disruptions (e.g., telehealth and other home-based HIV medical services). Our overarching hypotheses are: 1) COVID-19-related changes in sexual behavior and service disruptions have varied among US MSM in magnitude and timing by demographic factors, 2) these changes will alter HIV incidence across the pandemic era, and 3) targeted home-based HIV medical care retention interventions can curtail the impact of clinical care disruptions on HIV transmission. In AIM 1, we will triangulate data from two independent longitudinal studies of US MSM to describe the temporal patterns and demographic distribution of sexual distancing and HIV service disruptions. In AIM 2, we will use a network-based HIV transmission model to disentangle changes in HIV transmission versus screening to estimate HIV incidence among US MSM during and after the COVID-19 pandemic. In AIM 3, we will use a transmission model to determine the epidemiologic impact of targeted home-based HIV care retention interventions in a high burden jurisdiction. The findings of this project will both inform HIV surveillance efforts and guide the development of targeted HIV prevention programs. With this research and training program, the applicant will gain a multidisciplinary skill set combining epidemiologic methods, network science, and infectious disease modeling, while advancing our knowledge of HIV dynamics in the COVID era. This unique training will provide the technical skillset needed for the applicant to become a successful independent researcher and infectious disease epidemiologist.

项目概要目前有超过 120 万美国人感染人类免疫缺陷病毒 (HIV)，近 40,000 每年都有新的感染，艾滋病毒仍然是美国的一个主要公共卫生挑战。美国人口分布均匀：大约 70% 的感染发生在同性恋、双性恋和其他男性中男男性行为者 (MSM) 以及某些种族/族裔群体的 HIV 传播风险较高。尽管最近在生物医学预防和治疗方面取得了进展，但仍然很高，部分原因是 COVID-19 全球大流行造成的经济和社会混乱。加剧了这些差距，给艾滋病毒控制带来了新的挑战，破坏了艾滋病毒的获取预防和临床护理服务，并促使重大行为改变（包括减少性行为）活动，“性距离”）。这些变化可能会极大地影响美国艾滋病毒流行的轨迹。有报道称，大流行期间艾滋病毒诊断有所下降，但这些估计可能只是一个假设。减少筛查而不是减少传播的假象，因此计数不可靠。艾滋病毒传播对于提供艾滋病毒预防干预措施至关重要； COVID-19 大流行已经并将继续影响美国 MSM 的 HIV 动态，这是迫切需要的。由于服务中断而导致的传播增加可能会被性距离所抵消，但这取决于这些变化的时间模式和人口分布也可能通过以下方式得到缓解。解决临床中断问题的干预措施（例如远程医疗和其他家庭艾滋病毒医疗服务）。我们的首要假设是：1) 与 COVID-19 相关的性行为变化和服务中断美国男男性行为者之间的规模和时间因人口因素而有所不同，2）这些变化将改变艾滋病毒整个大流行时代的发病率，以及 3) 有针对性的家庭艾滋病毒医疗保留干预措施可以减少临床护理中断对 HIV 传播的影响在 AIM 1 中，我们将对两个数据进行三角测量。对美国 MSM 的独立纵向研究，描述了 MSM 的时间模式和人口分布性距离和艾滋病毒服务中断在 AIM 2 中，我们将使用基于网络的艾滋病毒传播模型。理清 HIV 传播与筛查的变化，以估计美国 MSM 中的 HIV 发病率在 COVID-19 大流行期间和之后，我们将使用传播模型来确定。高负担辖区有针对性的家庭艾滋病毒护理保留干预措施的流行病学影响。该项目的研究结果将为艾滋病毒监测工作提供信息，并指导针对性艾滋病毒的开发通过该研究和培训计划，申请人将获得多学科技能。结合流行病学方法、网络科学和传染病模型，同时推进我们的研究这种独特的培训将提供有关新冠病毒时代艾滋病毒动态的知识。申请人成为一名成功的独立研究员和传染病流行病学家。