NATIONAL HIV BEHAVIORAL SURVEILLANCE IN THE DISTRICT OF COLUMBIA

描述（由申请人提供）：艾滋病毒/艾滋病流行三十年来，以证据为基础的预防战略仍然是实施有效的公共卫生应对人类免疫缺陷病毒（艾滋病毒）的关键。大规模实施的有效预防模式在减缓社区内疾病传播方面取得了进展，但工作尚未完成。这一点在哥伦比亚特区最为明显，那里有3.2%的人口被诊断为艾滋病毒感染者。截至2008年底，共有16，513名地区居民居住在 艾滋病毒/艾滋病感染者，其中72.0%为男性，75.6%为黑人。被称为“现代流行病”的华盛顿特区（DC）的流行病集中在注射毒品使用者（IDU）和男男性行为者（MSM）中，同时在所有地区居民中普遍流行（3.2%）。也有证据表明存在显著的差异：在华盛顿特区，7.6%的40至49岁的人、7.1%的黑人男性和2.8%的黑人女性感染了艾滋病毒/艾滋病。在高风险的异性恋社区中，国家艾滋病毒行为监测系统收集了基于社区的样本数据，发现所有参与者中有5.2%，多达6.3%的妇女艾滋病毒呈阳性。该提案代表了哥伦比亚特区、艾滋病毒/艾滋病、肝炎、性病和结核病局（HAHSTA）与乔治华盛顿大学公共卫生和卫生服务学院流行病学和生物统计学系（GW）之间的公共卫生学术伙伴关系（成立于2006年）的延续。通过这一伙伴关系，并与广大社区合作，国家住房和城乡建设部已成功地完成了它所开展的每一个周期的财务管理和社会保障措施（N=543）。IDU（N=553）。HET（N=825）1.这使得该地区能够使用NHBS数据来推动艾滋病毒预防政策和计划的变化，包括引导资源扩大全面的，基于证据的艾滋病毒预防组合，改变当地的服务模式，并与个人保险公司，公共卫生系统，社区合作伙伴和学术界合作，以减缓艾滋病毒/艾滋病在国家首都的流行。NHBS系统的目的是在艾滋病毒/艾滋病发病率高的地区，在以人口为基础的高风险个人代表性样本中，检查感染艾滋病毒前的危险行为的流行情况。NHBS提供了一个更好的了解行为风险因素，利用当地的预防服务和方法，以达到需要测试和护理的人口。NHBS还提供了对未获得艾滋病毒预防或护理环境的人群中发生的情况的估计：它使人们能够深入了解这种流行病在通常希望保持隐藏的基本隐藏人群中的深度。通过这种方式，NHBS在华盛顿特区至关重要，因为当地的公共卫生基础设施正在努力应对一种并不总是容易接触到的严重流行病。在拟议的哥伦比亚特区NHBS研究中，将进行五项系列横断面研究，每年重点关注特定的高危人群：男男性行为者（MSM-3/4）、注射毒品使用者（IDU-3/4）和有艾滋病毒感染风险的异性恋者（HET-3）。我们还建议进行额外的模块，以收集B，C型肝炎，梅毒数据在每个周期，一个响应驱动的样本（RDS）的变性男性对女性（MTF）在MSM-3，并评估新的艾滋病毒检测技术在MSM-3。通过这种伙伴关系，HAHSTA已经成功地实施了NHBS，每年都有完整和及时的应计，在IDU和异性恋者中使用RDS，并与当地一个强大的学术机构合作，在MSM中使用基于场地的抽样（VBS）。在这份提案中，我们概述了未来五个周期的计划，以及另外三个新目标，最高度重视人类受试者和监测数据的保护，社区参与以及实施和数据传播的科学严谨性。除了实现过去的调查应计目标外，该伙伴关系还取得了其他具有公共卫生重要性的成就，这些成就将继续下去：这些包括与当地社区规划小组（CPG）的合作和传播，一个有70多名成员的明确的GW研究社区咨询委员会，与多个HAHSTA和GW Acuity和工作人员的合作，也是培训和发展下一代公共卫生专业人员的独特机会。

DESCRIPTION (provided by applicant): Thirty years into the HIV/AIDS epidemic evidence based prevention strategies remain critical to implement an effective public health response to human immunodeficiency virus (HIV). Effective prevention modalities implemented to scale have shown progress in slowing the spread of the disease within communities, but the work is not complete. Nowhere is this more evident than in the District of Columbia, where 3.2% of the population is diagnosed and living with HIV. At the end of 2008, there were 16,513 District residents living with HIV/AIDS, of whom 72.0% were male and 75.6% were Black. Dubbed a "Modem Epidemic," Washington, DC (DC) has concentrated epidemics among injecting drug users (IDU) and men who have sex with men (MSM), alongside a generalized epidemic among all District residents (3.2%). There is also evidence of striking disparities: 7.6% of people ages 40 to 49, 7.1% of black males, and 2.8% of black women in DC are living with HIV/AIDS. Among heterosexual communities at high risk, the National HIV Behavioral Surveillance (NHBS) system collected data on a community-based sample and found 5.2% of all participants, and as many as 6.3% of women, were HIV-positive. This proposal represents a continuation of the Public Health-Academic Partnership (established: 2006) between the District of Columbia, HIV/AIDS, Hepatitis, STD, and TB Bureau (HAHSTA) and the George Washington University School of Public Health and Health Services, Department of Epidemiology and Biostatistics (GW). Through this Partnership, and in collaboration with the community at large, NHBS has been successfully completed for each cycle it has undertaken FMSM (N=543). IDU (N=553). HET (N=825)1. This has allowed the District to use NHBS data to drive changes in HIV prevention policies and programs, including directing resources to scale up a comprehensive, evidence based, HIV prevention portfolio, shifting service paradigms locally, and working collaboratively with individual insurers, the public health system, community partners, and academia to slow the HIV/AIDS epidemic in the Nation's capital. The purpose of the NHBS system is to examine the prevalence of risk behaviors antecedent to acquisition of HIV in a population-based representative sample of individuals at high risk in areas with elevated HIV/AIDS rates. NHBS provides an improved understanding of behavioral risk factors, utilization of local prevention services and methods to reach the population in need of testing and care. NHBS also offers an estimate of what is happening among people not accessing HIV prevention or care settings: it allows insight into the depth of the epidemic among largely hidden populations that often wish to remain hidden. In this way, NHBS is essential in DC, as the local public health infrastructure grapples with a profound epidemic among people that are not always easily reached. In the proposed NHBS study in DC, five serial cross-sectional studies will be conducted, each year focusing on a specific population at high risk: men who have sex with men (MSM-3/4), injecting drug users (IDU-3/4), and heterosexuals at risk for HIV infection (HET-3). We also propose conducting additional modules to collect Hepatitis B, C, and syphilis data during each cycle, a respondent driven sample (RDS) of transgender male-to-females (MTF) during MSM-3, and evaluation of new HIV testing technologies in MSM-3. Through the partnership, HAHSTA has had demonstrated success in implementing NHBS with complete and on-time accrual each year, using RDS among IDU and heterosexuals, and venue based sampling (VBS) among MSM in partnership with a strong local academic institution. In this proposal, we outline plans to undertake the next five cycles, and three additional new objectives, with the highest regard for human subjects and surveillance data protection, community involvement, and scientific rigor in implementation and data dissemination. In addition to meeting past survey accrual goals, the Partnership has had other accomplishments of public health importance that will continue: these include collaboration with and dissemination to the local community planning groups (CPG), a well-defined GW Research Community Advisory Board with over 70 listed members, collaboration with multiple HAHSTA and GW Acuity and staff, and a unique opportunity for the training and development of the next generation of public health professionals.