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

项目摘要 这份提案描述了一项为期5年的研究计划，旨在解决我们在理解上的差距。 延迟获得艾滋病毒病毒的个人、地理和社会背景决定因素 在美国的深南地区，一个地区携带着 该国艾滋病毒流行的不成比例的负担。该提案利用了动态和 阿拉巴马大学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)和国家卫生部门的艾滋病毒部门 阿拉巴马州(AL)、路易斯安那州(LA)和密西西比州(密西西比州)的部门。这一新颖的研究方案 使用人群健康方法来评估新诊断个体的时间VS 并整合了一种混合方法来检查社会经济、人口统计和 结构性决定因素对VS在这一人群中发展的干预作用 加快抗逆转录病毒治疗(ART)的启动。这项建议的具体目的是：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)，以表征从HIV诊断到VS(&lt；200)时间的地理变异性 C/毫升)在确诊时年龄为13岁的≥患者中新报告的艾滋病毒病例中 2014年1月-2017年12月，在AL、LA和MS；2)确定个人和社区级别 AL、LA和VS的时间决定因素，包括量化地理空间编码方法 自1月起在确诊时年龄为13岁的≥人群中新报告的艾滋病毒病例中的MS 2014-2017年12月，并通过定性的关键线人访谈说明这些发现的背景 在艾滋病毒携带者、艾滋病毒治疗和社会服务提供者以及其他 AL、LA和MS中的社区利益相关者；以及3)让利益相关者参与开发快速 ART启动计划，重点放在南方腹地，时间过长 从HIV确诊到VS的时间。然后，我们将把这些结果合并到R01应用程序测试中 在南方腹地实施社区一级的快速艺术启动方案，重点是 从HIV诊断到VS的时间较长的地区。这项研究的结果将为 为更大规模的实施试验奠定基础，其中将包括对干预措施的严格评估 整合临床和公共卫生系统，旨在缩短VS在美国的时间 对成本效益的考虑。

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.