Evaluating ART for All HIV Seropositives: Can it work with the hardest cases?

评估所有艾滋病毒血清阳性者的抗逆转录病毒疗法：它可以用于最困难的病例吗？

• 批准号: 8543428
• 负责人: Aimee N Campbell
• 金额: $ 59.7万
• 依托单位: ST. LUKE'S-ROOSEVELT INST FOR HLTH SCIS
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8543428
• 关键词: Accounting; Acquired Immunodeficiency Syndrome; Adopted; Adoption; African American; Alcohol or Other Drugs use; Alcohols; Anti-Retroviral Agents; Area; CD4 Lymphocyte Count; CD4 Positive T Lymphocytes; Caring; Cities; Clinic; Clinical; Communities; Data; Data Analyses; Data Set; Data Sources; Diagnosis; Disease; Early treatment; Ecosystem; Education; Epidemic; Ethnic Origin; Evaluation; Feedback; Funding; Generations; Goals; HIV; HIV Infections; HIV diagnosis; HIV-1; Health; Healthcare; Illicit Drugs; Individual; Information Dissemination; International AIDS; Lead; Life; Link; Maintenance; Mental Health; Methods; Minority Groups; Modeling; New York City; Newly Diagnosed; Outcome; Patients; Persons; Pharmaceutical Preparations; Plasma; Policies; Prevention; Primary Health Care; Provider; Public Health; RNA; Race; Recommendation; Recruitment Activity; Reporting; Research; Research Personnel; Resource Allocation; Resources; Risk; Sampling; Services; Sexual Transmission; Sexually Transmitted Diseases; Social Conditions; System; Testing; Treatment Protocols; Viral; Viral Load result; Virus; Work; base; cohesion; cohort; design; high risk; improved; primary outcome; public health relevance; racial and ethnic disparities; social; socioeconomics; surveillance data; symposium; transmission process; treatment adherence

DESCRIPTION (provided by applicant): On World AIDS Day, December 1, 2011, the NYC Department of Health and Mental Hygiene (NYCDOHMH) announced a new policy that all HIV seropositives should be offered antiretroviral treatment (ART) regardless of CD4 cell count. The new policy was based primarily on "treatment as prevention" as a method for not only improving the health of people living with HIV who initiate ART early, but also as a means of reducing transmission of the virus. The NYCDOHMH set an ambitious goal for this new policy: by one year post HIV diagnosis, 80% of new HIV diagnoses will have reached viral suppression. There are over 3,400 new HIV infections occurring annually in NYC; recent data indicate 38% reached durable viral suppression in 2006-07 (i.e., all viral loads 400 copies/mL). The policy goal is ambitious, but if it were to be achieved, it would almost certainly lead to an "AIDS-free generation" - the central theme of the 2012 International AIDS Conference - in the city with the largest local HIV epidemic in the US. There are serious difficulties in achieving this policy goal, notably the persistent racial/ethnic disparities in HIV infection in the city, especially among African-Americans, and drug-related sexual transmission. The overarching purpose of this research is to provide multisystem data to evaluate the implementation of the policy and help determine the most efficient use of available resources for achieving the policy goal. The design and methods are informed by the ecological systems model, while the RE-AIM model guides the overall assessment of the implementation of the new policy. The study aims are: 1) to assess durable viral suppression (i.e., two consecutive viral load tests 400 HIV-1 RNA copies per mL of plasma) within 12 months of diagnosis among a) STD clinic cohort (N = 300) with problem substance use, and b) all new HIV diagnoses in NYC occurring during the project funding period (N=approximately 3,400/year); 2) to assess key indicators along the HIV treatment cascade among the STD clinic cohort as the percentage who (a) link to HIV care; (b) receive a recommendation to initiate ART; (c) initiate ART treatment; and (d) adhere to ART treatment; 3) to assess multisystem predictors of durable viral load suppression and other HIV treatment cascade indicators among the STD clinic cohort and cohort of all new HIV diagnoses in NYC, to include individual (e.g., race/ethnicity, substance use) and geospatial factors (e.g., socioeconomic conditions, social disorder, social cohesion, and spatial access to HIV-related healthcare); 4) to describe and contextualize quantitative outcomes in Aims 1-3 using STD cohort qualitative data; and 5) to describe the adoption, implementation, and maintenance of HIV treatment policies among HIV primary care providers. The endpoint of durable viral suppression increases

描述（由申请人提供）：在2011年12月1日世界艾滋病日，纽约市卫生和心理卫生部（NYCDOHMH）宣布了一项新政策，即所有HIV血清阳性者都应接受抗逆转录病毒治疗（ART），无论CD 4细胞计数如何。新政策的主要基础是“治疗即预防”，不仅是改善早期开始抗逆转录病毒疗法的艾滋病毒感染者健康的一种方法，而且是减少病毒传播的一种手段。NYCDOHMH为这项新政策设定了一个雄心勃勃的目标：到艾滋病毒诊断后一年，80%的新艾滋病毒诊断将达到病毒抑制。纽约市每年有超过3,400例新的艾滋病毒感染;最近的数据表明，2006-07年有38%的人达到了持久的病毒抑制（即，所有病毒载量400拷贝/mL）。这一政策目标雄心勃勃，但如果能够实现，几乎肯定会在美国艾滋病流行最严重的城市实现“无艾滋病一代”--这是2012年国际艾滋病大会的中心主题。在实现这一政策目标方面存在严重困难， 特别是该市艾滋病毒感染方面持续存在的种族/民族差异，特别是在非洲裔美国人中，以及与毒品有关的性传播。这项研究的首要目的是提供多系统的数据来评估政策的执行情况，并帮助确定最有效地利用现有资源实现政策目标。设计和方法是由生态系统模型，而RE-AIM模型指导新政策的实施的总体评估。研究目的是：1）评估持久的病毒抑制（即，a）使用问题药物的STD诊所队列（N = 300）和B）项目资助期间纽约市所有新的HIV诊断，在诊断后12个月内进行两次连续病毒载量检测（400 HIV-1 RNA拷贝/mL血浆）（N=约3，400人/年）; 2）评估性病诊所队列中艾滋病毒治疗级联的关键指标，即（a）与艾滋病毒护理相关的百分比;沿着;（B）接受开始ART的建议;（c）开始ART治疗;和（d）坚持ART治疗; 3）评估STD诊所队列和纽约市所有新HIV诊断队列中持久病毒载量抑制和其他HIV治疗级联指标的多系统预测因子，以包括个体（例如，种族/民族，物质使用）和地理空间因素（例如，社会经济条件、社会混乱、社会凝聚力和获得艾滋病毒相关医疗保健的空间）; 4）使用性病队列定性数据描述目标1-3中的定量结果并将其置于情境中; 5）描述艾滋病毒初级保健提供者采用、实施和维持艾滋病毒治疗政策。持久病毒抑制的终点增加