Viral Suppression for People with HIV with Low Incomes: Study of Disparities, Health Equity, and Best Practices

低收入艾滋病毒感染者的病毒抑制：差异、健康公平和最佳实践的研究

基本信息

批准号：
10619064
负责人：
Kathleen Ann McManus
金额：
$ 73.68万
依托单位：
UNIVERSITY OF VIRGINIA
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-04-24 至 2027-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10619064
关键词：
Acquired Immunodeficiency Syndrome Adopted Advocate Age Arizona Binding Black AIDS Black race Budgets Caring Client Communities Data Decision Making Development Disparity District of Columbia Eligibility Determination Epidemic Epidemiologic Methods Epidemiology Ethnic Origin Florida Funding Geography Goals HIV HIV Infections Hawaii Health Health Care Costs Health Services Accessibility Healthcare Incidence Income Individual Interruption Intervention Interview Laws Leadership Left Low income Mediating Morbidity - disease rate North Carolina Outcome Persons Pharmaceutical Preparations Policies Policy Maker Population Principal Investigator Public Health Qualifying Qualitative Methods Race Regulation Research Research Personnel Resource Allocation Resources South Carolina Structure Subgroup Surveys Tennessee Territoriality Translating Translations Underinsured Uninsured United States Variant Viral Viral Load result Virginia Work antiretroviral therapy cohort comorbidity disparity reduction experience falls federal poverty level flexibility geographic disparity health care delivery health equity improved insurance plan mortality novel prevent programs safety net simulation transmission process

项目摘要

PROJECT SUMMARY/ABSTRACT People with HIV (PWH) need consistent access to care and antiretroviral therapy (ART) to achieve the sustained viral suppression (VS) critical for individual health (reduced morbidity, comorbidities, and mortality) and public health (preventing transmission of HIV). The United States (US) has significant geographic disparities in HIV VS for PWH with low incomes who rely on state AIDS Drug Assistance Programs (ADAPs), ranging 53% to 99%. ADAPs support 26% of PWH in the US with a $2.4 billion annual budget. As a key part of the US HIV healthcare delivery safety net, ADAPs provide free ART by direct provision or through ADAP-subsidized insurance plans. ADAP implementation varies widely because individual state ADAPs have decision-making flexibilities for health- care delivery programs and policies. Additionally, how ADAPs perform for different subgroups remains unknown. Understanding how ADAPs can optimize VS could reduce healthcare costs, because each HIV infection averted saves $402,000. To support ending the US HIV epidemic, our long-term goal is to use epidemiologic, including causal inference framework, and qualitative methods, to identify how to improve VS for all PWH, including those with low incomes, through healthcare delivery programs. With a focus on disparities and health equity, our over- arching research question is what specific healthcare delivery programs and policies for PWH with low incomes increase sustained VS rates and reduce VS disparities related to race/ethnicity? Our team has studied ADAPs since 2014. Our study results have been used to advocate to successfully change healthcare laws. The Principal Investigator, the only researcher with federal funding to study this aspect of HIV healthcare delivery, and the interdisciplinary team will use expertise in novel causal epidemiology and qualitative methods. We have partner- ships with the National Alliance of State & Territorial AIDS Directors (NASTAD) and six state health departments providing access to multistate individual-level data (comprising 20% of ADAP clients; including ADAPs at VS rate extremes), and for a national study, we will interview AIDS/ADAP leadership. We will complete the following: Aim 1: we will decompose disparities in sustained VS related to race/ethnicity. We will quantify the mediating effect of a modifiable factor, ADAP healthcare delivery programs. Aim 2: we will quantify potential improvements in sustained VS for individual state ADAPs informed by state ADAP client mix. Using simulation for all state ADAPs, we will estimate the impact on sustained VS of ADAP clients changing to specific ADAP programs. Aim 3: we will perform interviews of AIDS/ADAP Directors across the nation. Using qualitative analyses, we will iden- tify the ADAP programs and policies that improve VS and improve health equity. Successful completion of this work will provide evidence to inform state/federal regulation and resource prioritization toward the goal of helping people achieve VS and interrupting HIV transmission. Our findings would allow state ADAPs, advocates, policy- makers, and Ending the HIV Epidemic initiative leaders to adopt best practices identified from our study and to develop new interventions (laws, guidance, funding) to optimize VS- translating data into policy and action.

项目概要/摘要 HIV 感染者 (PWH) 需要持续获得护理和抗逆转录病毒治疗 (ART)，以实现持续的治疗病毒抑制（VS）对于个人健康（降低发病率、合并症和死亡率）和公众至关重要健康（预防艾滋病毒传播）。美国 (US) 在艾滋病病毒感染方面存在显着的地理差异依赖州艾滋病药物援助计划 (ADAP) 的低收入感染者，比例为 53% 至 99%。 ADAP 每年预算 24 亿美元，为美国 26% 的感染者提供支持。作为美国艾滋病毒医疗保健的重要组成部分交付安全网，ADAP 通过直接提供或通过 ADAP 补贴的保险计划提供免费的 ART。 ADAP 的实施差异很大，因为各个州的 ADAP 具有卫生方面的决策灵活性。护理服务计划和政策。此外，ADAP 在不同亚组中的表现如何仍然未知。了解 ADAP 如何优化 VS 可以降低医疗成本，因为每次 HIV 感染都可以避免节省 402,000 美元。为了支持结束美国艾滋病毒流行，我们的长期目标是利用流行病学手段，包括因果推理框架和定性方法，以确定如何改善所有感染者的 VS，包括那些低收入者，通过医疗保健提供计划。着眼于差异和健康公平，我们的过度首要的研究问题是针对低收入感染者的具体医疗保健提供计划和政策是什么增加持续的 VS 率并减少与种族/民族相关的 VS 差异？我们的团队研究了 ADAP 自 2014 年以来。我们的研究结果已被用来倡导成功改变医疗保健法律。校长调查员是唯一一位获得联邦资助研究艾滋病毒医疗保健服务这一方面的研究人员，跨学科团队将利用新型因果流行病学和定性方法方面的专业知识。我们有合作伙伴—— 与国家和地区艾滋病主管联盟 (NASTAD) 以及六个州卫生部门合作提供对多州个人级数据的访问（包括 20% 的 ADAP 客户端；包括 VS 的 ADAP）率极端），并且对于一项全国性研究，我们将采访 AIDS/ADAP 领导层。我们将完成以下工作：目标 1：我们将分解与种族/民族相关的持续 VS 差异。我们将量化中介可修改因素 ADAP 医疗保健提供计划的影响。目标 2：我们将量化潜在的改进在由状态 ADAP 客户端组合通知的各个状态 ADAP 的持续 VS 中。对所有状态使用模拟 ADAP，我们将估计 ADAP 客户更改为特定 ADAP 计划对持续 VS 的影响。目的 3：我们将对全国艾滋病/ADAP 主管进行采访。通过定性分析，我们将确定强化 ADAP 计划和政策，以改善 VS 和改善健康公平。顺利完成本次工作将为州/联邦监管和资源优先顺序提供证据，以实现帮助目标人们实现 VS 并阻断 HIV 传播。我们的研究结果将使各州 ADAP、倡导者、政策- 制造商和终结艾滋病毒流行倡议的领导者采用我们研究中确定的最佳实践，并制定新的干预措施（法律、指导、资金）来优化 VS——将数据转化为政策和行动。