Computational approaches to understand the impact of social determinants of health on HIV care continuums

了解健康社会决定因素对艾滋病毒护理连续体影响的计算方法

• 批准号: 10447767
• 负责人: Anna Hotton
• 金额: $ 20.5万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-08 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10447767
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; Caring; Chicago; Chronic Disease; Cohort Studies; Communities; Complex; Computer Models; Computing Methodologies; Continuity of Patient Care; Criminal Justice; Cross-Sectional Studies; Data; Data Analyses; Data Sources; Decision Making; Dependence; Distal; Economics; Employment; Feedback; Geographic Locations; Goals; HIV; HIV diagnosis; Health; Housing; Illinois; Imprisonment; Incidence; Individual; Intervention; Literature; Logistics; Longterm Follow-up; Mediator of activation protein; Mental Health; Methods; Modeling; Obesity; Outcome; Pathway interactions; Periodicity; Persons; Population; Prevention; Public Health; Randomized; Records; Research; Resources; Risk; Science; Series; Sex Behavior; Statistical Methods; Structure; System; Testing; Time; Tobacco use; Unemployment; Viral; Work; barrier to care; base; black men who have sex with men; disease transmission; experience; experimental study; follow-up; future implementation; health inequalities; housing instability; implementation science; improved; improved outcome; insight; intervention effect; mathematical model; member; pre-exposure prophylaxis; preventive intervention; psychosocial; social; social health determinants; social structure; stressor; substance use; therapy development; transmission process; uptake; virtual; vulnerable community; working group

PROJECT SUMMARY/ABSTRACT Background: Black men who have sex with men (MSM) are disproportionately affected by HIV and other socio-structural factors that contribute to inequities along the HIV prevention and care continuum. Evidence suggests that factors such as housing instability, criminal justice involvement, and unemployment may pose significant barriers to engagement in HIV prevention and care for Black MSM. To date however, existing interventions have been ineffective at addressing these barriers for Black MSM. Because such interventions are resource intensive and logistically challenging, particularly for vulnerable communities who are often highly mobile and less likely to engage in research in traditional settings, guidance is needed at the intervention development stage to determine the most impactful and efficient intervention strategies. Agent-based models (ABMs) provide an opportunity to virtually evaluate candidate interventions to facilitate more efficient and timely intervention development. Because they allow for the conduct of counterfactual experiments, ABMs can also facilitate identification of effects that would be difficult to isolate using traditional approaches and provide valuable insights to guide implementation of HIV prevention interventions. Objective: Building on an existing modeling platform, this proposal will utilize multiple existing data sources to characterize relationships among socio-structural stressors, psychosocial mediators, and HIV prevention and care continuum outcomes among Black MSM and combine methods from implementation science and agent-based modeling to understand the potential impact of structural interventions for reducing HIV transmission. Methods: We will utilize local empirical data to create a realistic synthetic population within an existing agent-based model and apply statistical and computational methods to better understand how socio-structural factors impact engagement in HIV prevention and care continuums. We will then conduct a series of experiments to evaluate how socio- structural factors impact the uptake of existing biomedical interventions and compare outcomes under scenarios with different combinations of interventions Significance: A better understanding of where and how to focus intervention efforts offers potential to improve outcomes along the care continuum by addressing socio-structural barriers to HIV prevention and care engagement for Black MSM. Once developed, our approach can be adapted to other geographic areas to reflect prevention priorities for local health departments and can serve as an example application of ABM methods within implementation science to advance HIV prevention science.

项目总结/摘要 背景：与男性发生性关系的黑人男性（MSM）不成比例地受到艾滋病毒和其他疾病的影响。 社会结构因素导致艾滋病毒预防和护理连续体沿着出现不平等。证据 表明，住房不稳定，刑事司法参与和失业等因素可能会造成 在艾滋病毒的预防和护理参与黑人男男性行为者的重大障碍。然而，迄今为止， 干预措施在解决黑人男男性行为者的这些障碍方面是无效的。因为这种干预 资源密集型和后勤方面的挑战，特别是对脆弱社区而言， 移动的，不太可能在传统环境中从事研究，因此需要在干预时提供指导 发展阶段，以确定最具影响力和最有效的干预战略。代理人基模型 （ABM）提供了一个虚拟评估候选干预措施的机会， 干预发展。因为它们允许进行反事实实验，ABM也可以 促进确定使用传统方法难以分离的影响，并提供 指导艾滋病毒预防干预措施实施的宝贵见解。目标：在现有 建模平台，该提案将利用多个现有数据源来表征 社会结构压力因素、社会心理调节因素以及艾滋病毒预防和护理连续性成果， Black MSM和联合收割机结合了实现科学和基于代理的建模方法， 减少艾滋病毒传播的结构性干预措施的潜在影响。方法：我们将利用当地 经验数据，以创建一个现实的合成人口在现有的基于代理的模型，并应用 统计和计算方法，以更好地了解社会结构因素如何影响参与 艾滋病毒预防和护理工作继续进行。我们将进行一系列实验来评估社会- 结构性因素影响现有生物医学干预措施的采用，并比较 重要性：更好地了解在何处和如何采取干预措施 集中干预努力提供了改善结果的潜力，沿着护理连续体， 社会结构性障碍，艾滋病毒预防和护理参与黑人男男性行为者。一旦开发，我们的 该方法可适用于其他地理区域，以反映当地卫生部门的预防重点 并且可以作为ABM方法在实施科学中的应用实例，以促进艾滋病毒 预防科学。