Metropolitan Trajectories of HIV Epidemics, Drug Use, and Responses in US Key Populations

描述(由申请人提供)：30多年来，几乎所有关于艾滋病毒/艾滋病流行的研究和项目都集中在一个关键人群(KP)上，而不是其他KPS。这种孤立的做法大大限制了对艾滋病毒/艾滋病流行基本动态的科学了解，并导致我们错失了预防新感染的重要机会。该小组和其他人发表的和初步的分析表明，一个金伯利进程中的艾滋病毒/艾滋病流行病和方案可能会影响其他金伯利进程中的流行病和方案。例如，我们对美国96个最大的大都市统计地区(MSA)的分析表明，男男性行为者(MSM)中的HIV流行率预测注射吸毒者(PWID)中的HIV流行率，而PWID中的HIV流行率预测异性恋人群中的艾滋病发病率。对性网络的研究也表明，混合发生在KPS中。同样，针对一种KP的计划可能会影响其他KPS的流行：我们发现，注射器更换计划的存在预示着这些MSA中异性恋人群稍后较低的艾滋病发病率和死亡率。支持这些发现的一个关键原则是，艾滋病毒/艾滋病病毒像许多传染病一样，影响的是人群，而不仅仅是个人和网络。使用这种人群水平的方法，我们将开创一条新的高影响流行病学、规划和政策研究路线，研究艾滋病毒/艾滋病流行和规划是否以及如何在美国的三个KPS(即MSM、PWID和异性恋者)之间相互影响。这项对美国96个最大的MSA进行的纵向(1992-2015)队列研究将：(1)为每个KP和KP亚组(由种族/民族、年龄以及异性恋者和PWID定义的性别)创建MSA级别的艾滋病毒/艾滋病流行结果年度估计，以及这些KPS和KP亚组的艾滋病毒/艾滋病相关计划的存在和覆盖范围。然后，它将描述这些流行病学和计划变量中的每一个如何随时间和MSA而变化。使用这些流行病学和方案估计，它将(2)确定一个金伯利进程中的艾滋病毒/艾滋病流行是否以及如何影响其他金伯利进程中的流行病，包括整个金伯利进程和整个金伯利进程亚组；(3)发现与艾滋病毒/艾滋病相关的计划存在和覆盖的决定因素，以及每个金伯利进程和金伯利进程亚组的覆盖范围。目标2将以疾病政治生态学和流行病辩证模式为指导；目标3将以相关的社区行动理论为指导。通过实现这些目标并接受人口层面的观点，拟议的研究将推进一种新的研究范式，发现和描述跨金伯利进程动态如何帮助推动美国的艾滋病毒/艾滋病流行。调查结果还将为干预开辟新的领域，包括旨在防止一个金伯利进程内的流行病影响其他金伯利进程中的流行病的干预措施，并使整个金伯利进程的干预措施产生最大的积极影响。一组对每个金伯利进程内的流行病和项目有深入了解的研究人员已联合起来，整合他们在金伯利进程中的专门知识，以概念化和研究这些金伯利进程之间的相互作用。

DESCRIPTION (provided by applicant): For over 30 years, almost all studies of HIV/AIDS epidemics and programs have focused on one key population (KP) in isolation from other KPs. This siloed approach has significantly limited scientific understanding of the fundamental dynamics of HIV/AIDS epidemics, and has led us to miss vital opportunities to prevent new infections. Published and preliminary analyses by this team and others suggest that HIV/AIDS epidemics and programs in one KP may affect epidemics and programs in other KPs. For example, our analyses of the 96 largest US metropolitan statistical areas (MSAs) suggest that HIV prevalence among men who have sex with men (MSM) predicts HIV prevalence among people who inject drugs (PWID), and that HIV prevalence among PWID predicts AIDS incidence among heterosexuals. Studies of sexual networks also suggest that mixing occurs across KPs. Likewise, programs targeting one KP may affect epidemics in other KPs: we have found that the presence of syringe exchange programs predicts later lower AIDS incidence and mortality rates among heterosexuals in these MSAs. A key principle undergirding these findings has been that the HIV/AIDS virus, like many infectious diseases, affects populations, not just individuals and networks. Using this population-level approach, we will pioneer a novel line of high-impact epidemiologic, programmatic, and policy research on whether and how HIV/AIDS epidemics and programs affect one another across three KPs (i.e., MSM, PWID, and heterosexuals) in the US. This longitudinal (1992-2015) cohort study of the 96 largest MSAs in the US will (1) create MSA-level annual estimates of HIV/AIDS epidemic outcomes for each KP and KP subgroup (defined by race/ethnicity, age, and, for heterosexuals and PWID, gender), and of HIV/AIDS- related program presence and coverage for these KPs and KP subgroups. It will then describe how each of these epidemiologic and program variables varies across time and MSAs. Using these epidemiologic and programmatic estimates, it will (2) determine if and how HIV/AIDS epidemics in one KP affect and are affected by epidemics in other KPs, both overall and across KP subgroups; and (3) discover determinants of the presence and coverage of HIV/AIDS-related program presence and coverage for each KP and KP subgroup. Aim 2 will be guided by the Political Ecology of Disease and the Dialectical Model of Epidemics frameworks; Aim 3 will be guided by the related Theory of Community Action. By achieving these aims and embracing a population-level perspective, the proposed study will advance a new paradigm of research that will discover and describe how cross-KP dynamics help drive HIV/AIDS epidemics in the US. Findings will also open up new arenas for intervention, including interventions that seek to prevent epidemics in one KP from affecting epidemics in other KPs, and that maximize positive effects of interventions across KPs. A team of researchers with deep knowledge of epidemics and programs within each KP has joined forces to integrate their KP- specific expertise to conceptualize and study these cross-KP interactions.