Neighborhoods, Networks, and the HIV Care Continuum among HIV-infected MSM in NYC

纽约市感染 HIV 的 MSM 的社区、网络和 HIV 护理连续体

• 批准号: 10334491
• 负责人: Hong Van Nhu Tieu
• 金额: $ 78.8万
• 依托单位: NEW YORK BLOOD CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10334491
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Age; Alcohols; Area; Award; Biological; Black race; Caring; Characteristics; Communities; Conceptual Domain; Continuity of Patient Care; Crime; Data; Databases; Disadvantaged; Disclosure; Disease; Drug usage; Enrollment; Epidemic; Equipment and supply inventories; Ethnic Origin; Exposure to; Facility Accesses; Family member; Fostering; Friends; Funding; Green space; HIV; HIV Infections; Health; Health care facility; Hispanic; Home; Homophobia; Housing; Individual; Intervention; Investigation; Latino; Longitudinal Studies; Mediating; Medical; National Institute of Mental Health; Neighborhoods; New York City; Outcome; Overdose; Participant; Pathway interactions; Perception; Persons; Pharmaceutical Preparations; Pharmacy facility; Play; Policies; Poverty; Psychological Theory; Race; Research; Resources; Role; Social Disorganizations; Social Network; Social Work; Social support; Socialization; Socioeconomic Status; Stress and Coping; Structure; Testing; Time; United States; United States National Institutes of Health; Viral; Viral Load result; Visit; Work; alcohol and other drug; antiretroviral therapy; base; behavioral outcome; care outcomes; community violence; design; improved; infection rate; innovation; member; men who have sex with men; multilevel analysis; prevention service; programs; racial and ethnic disparities; racial discrimination; racial disparity; resilience; segregation; social; social capital; social deficits; social norm; social stigma; statistics; theories; therapy adherence; treatment as prevention; trend; urban area; urban planning

Abstract Marked disparities by race/ethnicity exist in HIV infection rates and engagement and retention in care among men who have sex with men (MSM) along the HIV care continuum. Compared with White MSM, HIV- infected Black and Hispanic/Latino MSM are less likely to be on antiretroviral therapy (ART), adhere to ART, and achieve viral suppression. Lower rates of care engagement and retention among Black and Latino MSM are influenced by factors beyond the individual. In order to uncover the neighborhood- and network-involved pathways that produce racial/ethnic disparities in HIV care outcomes, yielding an empirical basis for interventions and policies to fill gaps in the care continuum among Black and Latino MSM, systematic, theory- based investigation of the specific and intersecting neighborhood and network characteristics that relate to retention in care, ART adherence, and viral suppression must be engaged. Using socioecological and intersectional conceptual frameworks, several mid-range and micro social and psychological theories, and informed by our NIH/NIMH R56-funded formative research, we propose to identify neighborhood-and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and ART adherence) among 550 HIV-infected MSM living in New York City (NYC) via a longitudinal study. We will investigate the influence of neighborhood composition and four neighborhood-level characteristics domains, testing theoretical pathways of influence across the different neighborhoods in which MSM live, socialize, and receive HIV care. The Specific Aims are, among HIV-infected MSM in NYC: Aim 1: To use spatial analysis to characterize clustering and spatial trends in HIV care outcomes. Aim 2: To examine HIV care outcomes by race/ethnicity in relationship to longitudinal changes in: 2a) Exposure to neighborhoods of potential influence (home; social; health facility access); 2b) Neighborhood characteristics conceptual domains (community violence/physical disorder/social disorganization; AOD use factors; social norms; community resources); 2c) Social networks. Aim 3: To use multilevel modeling to assess associations among changes over time in exposure to the neighborhood characteristics and changes in social networks with HIV care outcomes by race/ethnicity, while assessing the potential mediating and moderating effects of individual- and network-level factors. The study will employ an innovative approach combining geospatial mapping of neighborhoods with multilevel modeling, spatial statistics, and an existing, extensive geospatial database. It will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood-, network-, and individual-levels, to improve HIV care outcomes for MSM, particularly for Black and Latino MSM.

摘要 在艾滋病毒感染率以及参与和继续接受护理方面存在着明显的种族/族裔差异 沿着艾滋病毒护理连续体的男男性行为者。与白色男男性接触者相比， 受感染的黑人和西班牙裔/拉丁裔男男性行为者不太可能接受抗逆转录病毒治疗（ART），坚持ART， 达到抑制病毒的目的。黑人和拉丁裔男同性恋者的护理参与率和保留率较低 都受到个体以外因素的影响为了揭示社区和网络参与 在艾滋病毒护理结果中产生种族/民族差异的途径， 干预措施和政策，以填补黑人和拉丁美洲男男性行为者之间的护理连续性，系统，理论， 基于对特定和交叉的邻域和网络特征的调查， 保持护理，坚持ART和病毒抑制必须参与。 利用社会生态学和交叉概念框架， 和心理学理论，并通过我们的NIH/NIMH R56资助的形成性研究，我们建议 确定与艾滋病毒护理连续体结果（病毒）相关的社区和网络水平特征 抑制、继续护理和坚持抗逆转录病毒疗法）在纽约市550名感染艾滋病毒的男男性行为者中进行 (NYC)通过纵向研究。我们将调查邻里组成和四个影响 邻里水平的特征领域，测试理论上的影响途径，在不同的 MSM居住、社交和接受艾滋病护理的社区。 具体目标是，在纽约市感染艾滋病毒的男男性行为者中： 目的1：使用空间分析来表征艾滋病毒护理结果的聚类和空间趋势。 目标2：按种族/族裔检查艾滋病毒护理结果与以下方面纵向变化的关系：2a） 接触有潜在影响的社区（家庭、社会、卫生设施）; 2b）社区 特征概念领域（社区暴力/身体障碍/社会解体; AOD使用 因素;社会规范;社区资源）; 2c）社交网络。 目的3：使用多层次模型评估暴露于 社区特征和社交网络的变化与艾滋病毒护理结果，按种族/民族，而 评估个人和网络层面因素的潜在中介和调节作用。 该研究将采用一种创新的方法，将社区的地理空间映射与 多级建模、空间统计和现有的广泛地理空间数据库。它将直接 多层次干预设计的影响，解决邻里，网络， 在个人层面，改善男男性行为者的艾滋病毒护理结果，特别是黑人和拉丁美洲男男性行为者。