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.

项目概要摘要 艾滋病毒仍然是美国的一个主要公共卫生问题，给人们带来了不成比例的负担 美国南部地区（包括田纳西州）2019 年艾滋病毒感染者 (PWH) 的比例。 他们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 病毒载量受到抑制（65%），远低于美国终止艾滋病毒流行目标（90%）。 地区、农村男男性行为者（MSM）以及黑人和西班牙裔人继续承受最高的负担 田纳西州的艾滋病毒疾病负担和艾滋病毒连续护理结果较差。 孟菲斯/谢尔比县的差距更为明显，这是第一阶段 EHE 优先管辖区和 在这一公共卫生背景下，大都会统计区 (MSA) 的艾滋病毒发病率在美国排名第三。 田纳西州决定拒绝约 900 万美元的艾滋病毒检测和预防联邦资金 2023 年 6 月 1 日生效。拒绝联邦资助社区艾滋病毒服务对公共卫生的影响 考虑到多年的经验、深厚的机构知识和社区的信任，这些可能是深远的 此外，国家还宣布了新的“优先人群”，只负责一个任务。 过去十年中田纳西州发生的一些艾滋病毒病例（即急救人员、人口贩运受害者和 孕妇和儿童），以及已知的艾滋病毒高危人群和高危人群 这些变化代表了对这些服务的需求（即农村居民、MSM、黑人和西班牙裔人）。 紧急的准实验事件，需要进行评估以评估艾滋病毒预防和护理方面的变化 因此，我们的首要目标是提供近乎实时的评估。 田纳西州资助艾滋病毒检测和预防的政策变化是否以及如何影响艾滋病毒结果， 特别是在艾滋病毒高危人群中，我们处于独特的地位来开展这方面的工作。 建议，因为我们的研究团队在田纳西州临床艾滋病毒检测和预防方面拥有互补的专业知识， 艾滋病毒建模、卫生政策分析和定性研究，以确保项目及时启动 我们的研究结果将为近实时评估是否和延迟提供清晰、严格的证据。 田纳西州资助艾滋病毒预防和护理的政策变化如何影响艾滋病毒结果，特别是在 尽管重点关注田纳西州，但结果与更广泛的政策相关。 围绕联邦资助社区公共卫生组织的方向进行讨论 重要的是，我们的工作将支持田纳西州的社区。 他们通过利用我们独特的学术和影响力来实现结束艾滋病毒流行（EHE）的目标 基于社区的伙伴关系。