Examining the effects of neighborhood factors and geography on racial/ethnic disparities on achieving sustained viral suppression

项目摘要/摘要 在艾滋病毒携带者中，艾滋病毒传播和疾病进展为艾滋病的风险降低 (PLHIV)已经实现了病毒抑制。此前的研究已经测量了一年内的最后一次病毒载量 评估病毒抑制情况。然而，这一单一测量仅提供了一次病毒抑制状态 时间点，并不表示一年中持续的病毒抑制(所有病毒负载测试在 年200份/毫升)。特别是，属于种族/少数民族群体的艾滋病毒感染者受到障碍的挑战。 以实现并维持病毒抑制。其中一些障碍与物质和社会有关 社区因素，如生活在经济贫困的社区。几乎没有研究表明 关于邻居因素在实现持续病毒抑制中的作用的日期。因此，目标是 这项F31研究的目的是评估邻居、地理和距离因素对 在持续的病毒抑制方面存在种族/民族差异。为实现这一目标，二级数据分析将 使用迈阿密-戴德县瑞安·怀特艾滋病毒/艾滋病项目的管理数据进行调查，该项目 为约9600名未得到充分服务和未参保的少数民族艾滋病毒感染者提供艾滋病毒护理和治疗。这 拟议的研究旨在(1)确定与以下因素相关的个人和邻里层面的因素 居住在持续病毒抑制率较低的地理热点地区，(2)确定 种族/民族与持续的病毒抑制之间的关联的邻里劣势，以及(3) 检查种族/民族对持续的病毒抑制和 前往艾滋病毒病例管理网站和艾滋病药物援助计划药店的旅行时间和距离。这个 中心假设是，社区劣势和距离艾滋病毒护理机构的距离将有助于 在实现持续的病毒抑制方面存在种族/族裔差异。拟议的研究将使用多层次混合 估计个人和邻居因素与持续病毒之间的关联的效果建模 抑制和地理信息系统工具，以识别持续病毒抑制的热点并 确定前往艾滋病毒护理机构的旅行时间和距离。为了成功地实施这项拟议的研究 并启动一名年轻的少数民族调查员的研究生涯，建议在以下5个方面进行培训： (1)艾滋病毒护理和治疗差异，(2)艾滋病毒差异的社区和地理决定因素，(3) 多层次混合建模，(4)空间统计，以及(5)负责任的研究和专业行为 发展(赠款和科学写作)。这一学习和培训经验将有助于申请者 发展成为独立的健康差距研究人员，并提供必要的技能 帮助她成功竞争博士后资助或早期职业发展资助。 此外，这项研究的结果将确定邻居、地理和距离因素可能是 有针对性地确保对脆弱的PLHIV病毒载量进行持续和长期的抑制。

Project Summary/Abstract The risk of HIV transmission and disease progression to AIDS decreases among people living with HIV (PLHIV) that have achieved viral suppression. Prior studies have measured the last viral load in a year to assess viral suppression. However, this single measurement only provides viral suppression status at a single point in time and does not indicate sustained viral suppression throughout a year (all viral load tests within a year <200 copies/mL). Particularly, PLHIV belonging to racial/ethnic minority groups are challenged by barriers to achieving and maintaining viral suppression. Some of these barriers are related to physical and social neighborhood factors such as living in economically deprived neighborhoods. There has been little research to date about the role of neighborhood factors in achieving sustained viral suppression. Therefore, the objective of this F31 study is to assess the contribution of neighborhood, geographic and distance factors on racial/ethnic disparities in sustained viral suppression. To address this objective, secondary data analysis will be conducted using administrative data from the Miami-Dade County Ryan White HIV/AIDS Program, which provides HIV care and treatment to approximately 9,600 underserved and uninsured minority PLHIV. This proposed research study aims to (1) identify individual and neighborhood level factors that are associated with residing in geographic hotspots of low sustained viral suppression, (2) identify the moderating effect of neighborhood disadvantage on the association between race/ethnicity and sustained viral suppression, and (3) examine the moderating effect of race/ethnicity on the association between sustained viral suppression and travel time and distance to HIV case management sites and AIDS Drug Assistance Program pharmacies. The central hypothesis is that neighborhood disadvantage and distance to HIV care facility will contribute to racial/ethnic disparities in achieving sustained viral suppression. The proposed study will use multi-level mixed effects modeling to estimate the association between individual and neighborhood factors and sustained viral suppression and geographic information system tools to identify hotspots of sustained viral suppression and to determine travel time and distance to HIV care facilities. In order to successfully implement this proposed study and launch the research career of a young minority investigator, training in the following 5 areas are proposed: (1) HIV care and treatment disparities, (2) neighborhood and geographic determinants of HIV disparities, (3) multilevel mixed modeling, (4) spatial statistics, and (5) responsible conduct of research and professional development (grant and scientific writing). This study and training experience will facilitate the applicant’s development towards becoming an independent health disparities researcher and provide essential skills to help her successfully compete for a post-doctoral grant or an early career development grant funding. Furthermore, findings from this study will identify neighborhood, geographic, and distance factors that may be targeted to ensure consistent and long-term viral load suppression for vulnerable PLHIV.