A Multimethod Assessment of the Clinical, Economic & Social Impact of the Rejection of Federal HIV Prevention Funds in Tennessee

临床、经济的多方法评估

• 批准号: 10864276
• 负责人: Tara McKay
• 金额: $ 69.59万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-25 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10864276
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Affect; Area; Award; Behavioral; Black Populations; Black race; Caring; Categories; Cells; Centers for Disease Control and Prevention (U.S.); Child; Client; Clinical; Communities; Continuity of Patient Care; County; Data; Data Sources; Diagnosis; Disease; Disparity; Disparity population; Ensure; Epidemic; Ethnic Origin; Evaluation; Event; Funding; Gender; Geography; Goals; Grant; HIV; HIV Infections; HIV diagnosis; Health; Health Disparities Research; Health Policy; Health system; Hispanic Populations; Human; Human immunodeficiency virus test; Incidence; Individual; Institution; Interview; Knowledge; Link; Measures; Methods; Minority; Modeling; National Institute on Minority Health and Health Disparities; Outcome; Persons; Phase; Policies; Policy Analysis; Population; Positioning Attribute; Pregnant Women; Prevention program; Public Health; Qualitative Research; Quality-Adjusted Life Years; Quasi-experiment; Race; Research Priority; Rural; Sampling; Services; Sex Orientation; Social Impacts; Surveillance Program; Tennessee; Time; Trust; United States; Viral; Viral Load result; WFDC1 gene; Work; black men who have sex with men; burden of illness; care outcomes; clinical care; community organizations; community transmission; cost; cost effectiveness; cost per quality-adjusted life year; economic evaluation; experience; first responder; high risk; improved; men who have sex with men; metropolitan; mortality; pre-exposure prophylaxis; prevention service; programs; rural area; rural dwellers; service organization; social; testing services; trafficking; transmission process

Project Summary Abstract HIV remains a major public health concern in the United States (US) with a disproportionate burden of disease in the US South, including Tennessee. The proportion of people with HIV (PWH) in Tennessee in 2019 who knew their HIV status (85%), were linked to care (61%), were retained in clinical care (59%), and had suppressed viral loads (65%), were well below US Ending the HIV epidemic goals (90%). People residing in rural areas, men who have sex with men (MSM), and Black and Hispanic people continue to bear the highest burden of HIV disease and have poor HIV continuum of care outcomes in Tennessee. These statewide disparities are more starkly mirrored in Memphis/Shelby County, a Phase 1 EHE Priority Jurisdiction and a Metropolitan Statistical Area (MSA) that ranks 3rd in the US for HIV incidence. In this public health context, the state of Tennessee has decided to reject ~$9 million dollars in federal funding for HIV testing and prevention effective June 1, 2023. The public health impact of rejecting federal funding for community-based HIV services is likely to be profound given the years of experience, deep institutional knowledge, and community trust these organizations have built. Further, the state has enunciated new “priority populations” responsible for only a handful of HIV cases in Tennessee in the past decade (i.e., first responders, victims of human trafficking, and pregnant women and children), in addition to the key populations known to have a high risk of HIV and high need for these services (i.e., rural residents, MSM, and Black and Hispanic people). These changes represent an urgent quasi-experimental event that requires evaluation to assess changes in HIV prevention and care outcomes related to this policy shift. Thus, our overarching goal is to provide a near-real-time evaluation of whether and how policy changes to funding HIV testing and prevention in Tennessee will affect HIV outcomes, particularly among populations highly vulnerable to HIV. We are uniquely positioned to perform the work in this proposal as our study team has complementary expertise in Tennessee clinical HIV testing and prevention, HIV modeling, health policy analysis, and qualitative research to ensure the timely initiation of the project with minimum delay. Our findings will provide clear, rigorous evidence in a near-real-time evaluation of whether and how policy changes to funding HIV prevention and care in Tennessee affect HIV outcomes, particularly among populations highly vulnerable to HIV. Although focused on Tennessee, results are relevant to broader policy discussions around the direction of federal funding to community-based organizations for public health programs already emerging across the US South. Importantly, our work will support Tennessee communities in reaching their Ending the HIV Epidemic (EHE) goals through the leveraging of our unique academic and community-based partnerships.

项目摘要摘要 艾滋病毒仍然是美国（美国）的主要公共卫生问题 美国南部的疾病，包括田纳西州。 2019年，田纳西州艾滋病毒（PWH）患者的比例 谁知道自己的艾滋病毒状况（85％），与护理有关（61％），保留在临床护理中（59％），并且 被抑制的病毒载量（65％）远低于我们结束HIV流行目标（90％）的美国。居住的人 粗糙的地区，与男人发生性关系的男人以及黑人和西班牙裔人继续拥有最高 艾滋病毒疾病的负担，田纳西州的艾滋病毒连续性较差。这些全州 在孟菲斯/谢尔比县，差距更为明显，第1期优先管辖权和一个 大都会统计区（MSA）在美国为HIV事件中排名第三。在这种公共卫生方面， 田纳西州已决定拒绝约900万美元的联邦资金用于HIV测试和预防 自2023年6月1日起生效。拒绝联邦资助基于社区的艾滋病毒服务的公共卫生影响 鉴于多年的经验，深厚的机构知识和社区信任，可能是深刻的 组织已经建立。此外，国家阐明了新的“优先人口” 在过去十年中，田纳西州少数艾滋病毒案件（即急救人员，违反人口贩运的行为， 孕妇和儿童），除了众所周知的艾滋病毒和高风险的关键人群外 需要这些服务（即粗糙的居民，MSM和黑人和西班牙裔人）。这些变化代表 紧急的准实验事件需要评估以评估艾滋病毒预防和护理的变化 与此政策转变有关的结果。这就是我们的总体目标是对 田纳西州的艾滋病毒测试和预防资金是否会改变政策是否会影响艾滋病毒结果， 特别是在高度容易艾滋病毒的人群中。我们在这方面独特地执行工作 提案作为我们的研究团队在田纳西州临床HIV测试和预防方面拥有完整的专业知识， 艾滋病毒建模，卫生政策分析和定性研究，以确保与该项目的及时启动 最小延迟。我们的发现将在近实时的时间评估中提供明确，严格的证据 田纳西州的预防艾滋病毒预防和护理的政策如何影响艾滋病毒的结果，尤其是 人群极易受到艾滋病毒的影响。尽管专注于田纳西州，但结果与更广泛的政策有关 讨论联邦资金向基于社区的组织提供公共卫生的方向 整个美国南部已经出现的计划。重要的是，我们的工作将支持田纳西州的社区 通过利用我们独特的学术和 基于社区的伙伴关系。