Geographic Variability in Time from HIV Diagnosis to Viral Suppression in the Deep South: A Roadmap to Accelerated Treatment Initiation

项目摘要 该提案描述了一项为期5年的研究计划，旨在解决我们理解中的差距 艾滋病毒感染延迟的个人、地理和社会背景决定因素 在美国（US）的深南地区（Deep South region），一个携带 该国艾滋病毒流行的不成比例的负担。该提案利用了一个动态和 来自亚拉巴马大学的经验丰富的研究人员的创新合作， 伯明翰（UAB）艾滋病研究中心（CFAR）和国家卫生部艾滋病毒司 在亚拉巴马（AL），路易斯安那州（LA）和密西西比（MS）的部门。这项新颖的研究计划 利用人群健康方法评估新诊断个体至VS的时间 并整合了混合方法的方法来检查社会经济，人口， 在制定干预措施时， 加速启动抗逆转录病毒治疗（ART）。这项建议的具体目标是：1） 利用各州公共卫生电子艾滋病毒/艾滋病报告收集的艾滋病毒监测数据 系统（eHARS），用于描述从艾滋病毒诊断到VS（<200 c/mL），在诊断时年龄≥13岁的新报告HIV病例中， 2014年1月至2017年12月在AL，LA和MS; 2）确定个人和社区层面 VS时间的决定因素，纳入定量地理空间编码方法，在AL，LA， 自2011年1月以来，确诊时年龄≥13岁的新报告艾滋病毒病例中的MS 2014-2017年12月，并将这些调查结果与定性的关键线人访谈结合起来 艾滋病毒感染者、艾滋病毒治疗和社会服务提供者以及其他 AL、LA和MS的社区利益相关者;以及3）让利益相关者参与制定快速 ART启动计划侧重于南方腹地的地区， 从HIV诊断到VS的时间。然后，我们将这些结果纳入R 01应用程序测试 在南方腹地实施社区一级的快速抗逆转录病毒治疗启动计划，重点是 从艾滋病诊断到VS的时间较长的地区。这项研究的结果将奠定 为更大规模的实施试验奠定基础，其中包括对干预措施的严格评估 整合临床和公共卫生系统，旨在改善美国的VS时间， 考虑成本效益。

Project Abstract This proposal describes a 5-year research plan that seeks to address gaps in our understanding of the individual, geographic, and sociocontextual determinants of delays in achieving HIV viral suppression (VS) in the Deep South region of the United States (US), an area carrying a disproportionate burden of the country’s HIV epidemic. The proposal leverages a dynamic and innovative collaboration of experienced investigators from the University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR) and the HIV Divisions of the state health departments in Alabama (AL), Louisiana (LA), and Mississippi (MS). This novel research proposal utilizes a population-health approach to evaluate time to VS among newly diagnosed individuals and integrates a mixed-methods approach to examine the socioeconomic, demographic, and structural determinants of time to VS in this population in the development of an intervention to accelerate initiation of antiretroviral therapy (ART). The specific aims of this proposal are to: 1) Utilize HIV surveillance data collected by the states’ public health electronic HIV/AIDS Reporting System (eHARS) to characterize geographic variability in time from HIV diagnosis to VS (<200 c/mL) among newly reported HIV cases among those age ≥13 years at diagnosis between January 2014-December 2017 in AL, LA, and MS; 2) Identify individual and community-level determinants of time to VS, incorporating quantitative geospatial coding methods, in AL, LA, and MS among newly reported cases of HIV among those age ≥13 years at diagnosis from January 2014-December 2017 and contextualize these findings with qualitative key informant interviews among persons living with HIV (PLWH), HIV treatment and social services providers, and other community stakeholders in AL, LA, and MS; and 3) Engage stakeholders in developing a rapid ART initiation program focusing upon localities in the Deep South with disproportionately longer time from HIV diagnosis to VS. We will then incorporate these results in an R01 application testing the implementation of a community-level rapid ART initiation program in the Deep South, focusing on areas with longer time from HIV diagnosis to VS. Results of this research will lay the groundwork for a larger implementation trial that will include rigorous evaluation of interventions integrating clinical and public health systems aimed at improving time to VS in the US with consideration for cost-effectiveness.