The DC Cohort: A Longitudinal Population-Based Cohort Study of People Living with HIV in Washington, DC

华盛顿特区队列：对华盛顿特区艾滋病毒感染者进行的一项基于人群的纵向队列研究

• 批准号: 10625851
• 负责人: Amanda Derryck Castel
• 金额: $ 478.41万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10625851
• 关键词: Achievement; Acquired Immunodeficiency Syndrome; Address; Area; Basic Science; Capital; Caring; Cessation of life; Cities; Clinic; Clinical; Cohort Studies; Collection; Communities; Computerized Medical Record; Continuity of Patient Care; Data; Data Collection; Data Linkages; Data Sources; Databases; Effectiveness; Electronic Health Record; Enrollment; Epidemic; Epidemiology; Feedback; Framingham Heart Study; Funding; Future; Geography; Goals; HIV; HIV diagnosis; Health; Health Resources; High Prevalence; Infrastructure; Intervention; Intervention Studies; Knowledge; Laboratories; Learning; Link; Longitudinal cohort; Longitudinal cohort study; Medical; Molecular Epidemiology; Monitor; National Institute of Allergy and Infectious Disease; Newly Diagnosed; Outcome; Participant; Patient Outcomes Assessments; Performance; Persons; Pharmacy facility; Population; Positioning Attribute; Prevalence; Prevention; Productivity; Provider; Public Health; Quality of Care; Reduce health disparities; Research; Research Personnel; Research Proposals; Resources; Risk; Services; Social Behavior; Testing; Therapeutic; Thinking; Time; United States National Institutes of Health; Viral; Washington; Work; age group; care outcomes; clinical research site; cohort; community engagement; comorbidity; dashboard; data repository; data visualization; efficacy evaluation; epidemiology study; health disparity; implementation science; improved; novel; novel therapeutics; population based; response; tool; transmission process; urban area

Project Abstract Washington, DC has approximately 13,000 people living with HIV (PLWH) and is one of the HIV “hotspots” in the US that collectively contribute to 50% of new HIV diagnoses. As we strive to end the HIV epidemic, the ability to characterize persons who are newly diagnosed with HIV, effectively direct treatment efforts for HIV and its co-occurring conditions, and use novel prevention tools to avert further transmissions, are of critical importance. The DC Cohort, a longitudinal cohort study of over 10,000 PLWH receiving care at 15 clinical sites in DC, is uniquely positioned to help end the HIV epidemic. The Cohort was launched in 2011 with the goal of bending the trajectory of the HIV epidemic in DC by improving the quality of care. The Cohort engages academic and community-based clinics, links to DC Health Department (DOH) databases, and provides near real-time performance feedback to clinics on HIV outcomes using a data visualization Clinical Dashboard. All of this is achieved through automated data extraction and harmonization of electronic medical records data from varied clinical settings and all age groups. The Cohort provides a representative, population-level and scientifically productive research resource that does not exist in most urban high prevalence cities. Building off the Cohort’s infrastructure and achievements, we will expand this robust population-level data repository to comprehensively and longitudinally track outcomes among PLWH in a high prevalence city. We will incorporate new data sources into the Cohort including administrative, service, pharmacy, additional co-morbidity and patient-reported outcomes data. Access to multi-level data will enhance the monitoring of HIV and co- morbidities outcomes. Next, we propose to use the Cohort to monitor the impact and effectiveness of Ending the HIV Epidemic (EHE) initiatives in DC and contribute lessons learned to national EHE efforts. The Dashboard will monitor key EHE indicators: retention in care; viral suppression (VS); availability, initiation and efficacy of new ARV therapeutics; and reductions in health disparities. With this tool, local HIV providers and the DC DOH can support those at greatest risk for suboptimal outcomes. Finally, we will use the Cohort to develop pioneering interventions to improve the quality of care among PLWH. We will partner with the DC Center for AIDS Research, local and national HIV investigators, and community stakeholders to identify and develop clinical, epidemiologic, socio-behavioral, basic science, and implementation science interventions to improve care. We will use the Cohort infrastructure to identify potential participants and clinical sites for these studies in support of NIH-funded and other research proposals. The goals of the Cohort align with OAR, NIAID, and EHE priorities which focus on reducing health disparities, achieving VS, monitoring quality of care, and improving the management of HIV-related clinical outcomes. The DC Cohort is an unparalleled clinical, research, and public health resource which enables us to monitor care in a high prevalence city. Lessons learned will produce generalizable knowledge that can be applied in other urban hotspots across the US.

项目摘要 华盛顿特区约有 13,000 名艾滋病毒感染者 (PLWH)，是美国艾滋病毒“热点”之一 美国总共占新艾滋病毒诊断的 50%。 在我们努力结束艾滋病毒流行时， 能够描述新诊断出的艾滋病毒感染者的特征，有效指导艾滋病毒的治疗工作 及其同时发生的条件，并使用新颖的预防工具来避免进一步传播，至关重要 DC 队列是一项纵向队列研究，涉及 15 个临床中心接受护理的 10,000 多名感染者。 该队列于 2011 年启动，旨在帮助结束艾滋病毒流行。 通过提高护理质量来扭转华盛顿特区艾滋病毒流行的轨迹。 学术和社区诊所，链接到华盛顿特区卫生局 (DOH) 数据库，并提供附近 使用数据可视化临床仪表板向诊所实时反馈艾滋病毒结果。 这是通过自动数据提取和电子病历数据的协调来实现的 不同的临床环境和所有年龄组提供了具有代表性的人口水平和水平。 大多数城市高流行率城市中不存在的科学生产力研究资源。 队列的基础设施和成就，我们将把这个强大的人口级数据存储库扩展到 我们将全面、纵向跟踪高流行城市中 PLWH 的结果。 队列中的新数据源，包括行政、服务、药房、其他合并症和 患者报告的结果数据的获取将加强对艾滋病毒和共同感染的监测。 接下来，我们建议使用队列来监测 Ending 的影响和有效性。 华盛顿特区的艾滋病毒流行 (EHE) 举措，并为国家 EHE 工作贡献经验教训。 仪表板将监测关键的 EHE 指标：病毒抑制（VS）的保留；可用性、启动和恢复； 新的抗逆转录病毒疗法的功效；以及减少健康差异。 华盛顿特区卫生部可以为那些面临次优结果风险最大的人提供支持。 我们将与 DC 合作，制定开创性的干预措施，以提高 PLWH 的护理质量。 艾滋病研究中心、地方和国家艾滋病毒调查人员以及社区利益相关者，以识别和 制定临床、流行病学、社会行为、基础科学和实施科学干预措施， 我们将使用队列基础设施来确定潜在的参与者和临床地点。 支持 NIH 资助的研究和其他研究提案 该队列的目标与 OAR、NIAID 一致。 和 EHE 优先事项，重点是减少健康差距、实现 VS、监测护理质量，以及 DC 队列是一个无与伦比的临床队列，旨在改善 HIV 相关临床结果的管理。 研究和公共卫生资源使我们能够监测高流行城市的护理情况。 学到的知识将产生可应用于美国其他城市热点的通用知识。