NATIONAL HIV BEHAVIORAL SURVEILLANCE IN THE DISTRICT OF COLUMBIA

描述(由申请人提供)：艾滋病毒/艾滋病流行三十年了，以证据为基础的预防战略对于有效应对人类免疫缺陷病毒(艾滋病毒)的公共卫生仍然至关重要。大规模实施的有效预防模式在减缓疾病在社区内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尤为明显，那里3.2%的人口被诊断为艾滋病毒携带者。截至2008年底，共有16,513名地区居民与 HIV/AIDS，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)集中在注射吸毒者(IDU)和男男性行为者(MSM)中流行，同时在所有地区居民中普遍流行(3.2%)。也有明显差异的证据：哥伦比亚特区40岁至49岁的人中有7.6%的人感染艾滋病毒/艾滋病，7.1%的黑人男性和2.8%的黑人妇女患有艾滋病毒/艾滋病。在高危异性恋社区中，国家艾滋病毒行为监测系统(NHBS)收集了以社区为基础的样本数据，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。这项提议是哥伦比亚特区、艾滋病毒/艾滋病、肝炎、性传播疾病和结核病局(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)之间公共卫生-学术伙伴关系(2006年建立)的延续。通过这一伙伴关系，并与广大社区合作，成功地完成了国家健康保险计划的每个周期(N=543)。IDU(N=553)。HET(N=825)1.这使得该地区能够利用NHBS数据推动艾滋病毒预防政策和方案的变化，包括引导资源扩大全面的、以证据为基础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，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/艾滋病发病率较高的地区以人群为基础的高危个人代表性样本中检查感染艾滋病毒前危险行为的流行率。NHBS有助于更好地了解行为风险因素、当地预防服务的利用以及接触到需要检测和护理的人群的方法。NHBS还提供了对未进入艾滋病毒预防或护理环境的人正在发生的情况的估计：它使人们能够深入了解通常希望隐藏起来的基本上隐藏的人群中流行病的深度。在这种情况下，全国健康保险制度在哥伦比亚特区是必不可少的，因为当地的公共卫生基础设施正在努力应对人们中的一种深刻的流行病，而这种流行病并不总是很容易接触到。在哥伦比亚特区拟议的NHBS研究中，将进行五项连续的横断面研究，每年重点关注特定的高危人群：男男性行为者(MSM-3/4)、注射吸毒者(IDU-3/4)和艾滋病毒感染风险的异性恋者(HET-3)。我们还建议在每个周期中进行额外的模块来收集乙肝、丙型肝炎和梅毒的数据，在MSM-3期间对变性人从男性到女性(MTF)的受访者驱动样本(RDS)，以及对MSM-3中新的艾滋病毒检测技术的评估。通过这种伙伴关系，HAHSTA已经成功地实施了NHBS，每年都能按时完成，在注射吸毒者和异性恋者中使用RDS，并与当地一家强大的学术机构合作，在MSM中使用基于地点的抽样(VBS)。在这项提案中，我们概述了未来五个周期的计划和三个额外的新目标，高度重视人类受试者和监测数据保护、社区参与以及执行和数据传播方面的科学严格性。除了实现过去的调查应计目标外，该伙伴关系还将继续取得其他对公共卫生具有重要意义的成就：其中包括与当地社区规划团体(CPG)的合作和向其传播；一个由70多名成员组成的明确的GW研究社区咨询委员会；与多个HAHSTA和GW Acuity和工作人员开展的合作；以及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.