Examining Social Ecological and Network Factors to Assess Epidemiological Risk in a Large National Cohort of Cisgender Women

项目摘要 虽然联合国艾滋病毒预防战略有所改进，艾滋病毒发病率继续下降， 美国认为，仍然迫切需要加强和推进预防科学， 已经停滞，特别是在有色人种的顺性别女性中。中心的最新监测数据 疾病控制和预防中心的数据显示，截至2019年，所有新的艾滋病毒诊断中约有7,000例是 在cisgender妇女（以下简称“妇女”）中确定。传统的人口统计和 行为风险因素不足以确定易受艾滋病毒感染的妇女。最近的研究 使用风险算法来确定暴露前预防（PrEP）的合格性， 女性的预测能力与男性同性性行为者的良好预测价值形成对比。 查明易受艾滋病毒感染的妇女对于发展和部署 有针对性的预防方法。虽然妇女感染艾滋病毒的方式是众所周知的，但异性恋者感染艾滋病毒的情况并不多见。 接触（85%）被确定为妇女中最常见的艾滋病毒传播方式，其次是15%的 对于注射药物使用，对社会生态因素知之甚少（例如，社区，网络，地理空间， 和政策因素）。广义上说，除了个人行为之外， 与美国妇女感染艾滋病毒的风险增加有关， 不平等、收入、遭受家庭暴力和性暴力、无家可归和性伴侣 特色尽管如此，确定预测血清转换的特征组合， 妇女并将她们确定为PrEP的候选人一直具有挑战性。为了克服这一差距， 作为对RFA-AI-21-058的回应，我们建议利用创新的数字方法建立知识库 为那些在行为上易受艾滋病毒感染的美国女性提供帮助。知识库将包括一个 我们将收集1 800名妇女的艾滋病毒和性传播感染样本 发病率数据以及社会和性网络数据，与开源大数据相结合，以了解艾滋病毒风险 在易感染艾滋病毒的妇女中。我们的研究团队在使用数字技术方面拥有丰富的经验， 招募研究参与者的方法（通过电子方法和地理空间分析）。充分利用 我们的专业知识，我们将使用发达的知识库，以确定理论驱动的艾滋病毒的相关性， 血清转化、STI发病率和PrEP摄取的预测因素。研究结果将增加我们对 妇女感染艾滋病毒的脆弱性，加强PrEP资格的确定，并为干预措施提供信息， 降低生活在美国的妇女中艾滋病毒和性传播感染的发病率。

PROJECT SUMMARY While HIV prevention strategies have improved and HIV incidence rates continue to decrease in the United States (US), a critical need remains to strengthen and advance prevention science where declines appear to have stalled, particularly among cisgender women of color. The most recent surveillance data from the Centers for Disease Control and Prevention demonstrate that as of 2019, about 7,000 of all new HIV diagnoses were identified among cisgender women (hereafter simply referred to as “women”). Traditional demographic and behavioral risk factors are insufficient to identify women who are vulnerable to HIV infection. Recent research on the use of risk algorithms to determine pre-exposure prophylaxis (PrEP) eligibility demonstrated poor predictive power for women in contrast to good predictive value among men who have sex with men. Identifying women who are vulnerable to HIV infection is crucial for the development and deployment of tailored prevention approaches. While the mode of HIV acquisition for women is well known, with heterosexual contact (85%) identified as the most frequent mode of HIV transmission among women, followed by 15% due to injection drug use, less is known about the social-ecological factors (e.g., community, network, geospatial, and policy factors) associated with HIV seroconversion. Broadly, several factors beyond individual behavior have been associated with increased risk for HIV acquisition among women in the US such as gender inequality, income, exposure to domestic and sexual violence, homelessness, and sex partner’s characteristics. Nonetheless, identifying the combination of characteristics that predict seroconversion among women and establish them as candidates for PrEP has been challenging. To overcome this gap and in response to RFA-AI-21-058, we propose to harness innovative digital methods to establish a knowledgebase for women living in the US who are behaviorally vulnerable to HIV. The knowledgebase will consist of a national cohort of 1,800 women from whom we will collect HIV and sexually transmitted infections (STIs) incidence data and social and sexual network data, paired with open-source big data to contextualize HIV risk among women vulnerable to HIV infection. Our study team has extensive experience in using digital approaches to recruit study participants (through electronic methods and geospatial analytics). Capitalizing on our expertise, we will use the developed knowledgebase to identify theoretically-driven correlates of HIV seroconversion, STI incidence, and predictors of PrEP uptake. Findings will increase our understanding of women’s vulnerabilities to HIV infection, enhance identification of PrEP eligibility, and inform interventions to decrease the incidence of HIV and STIs among women living in the US.