Influence of neighborhoods and networks on the HIV care continuum among HIV-infected MSM in NYC

社区和网络对纽约市艾滋病毒感染男男性行为者艾滋病毒护理连续性的影响

• 批准号: 9534290
• 负责人: Hong Van Nhu Tieu
• 金额: $ 81.78万
• 依托单位: NEW YORK BLOOD CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9534290
• 关键词: AIDS prevention; AIDS/HIV problem; Age Distribution; Alcohols; Area; Biological; Caring; Characteristics; Communities; Conceptual Domain; Continuity of Patient Care; Crime; Data; Databases; Disclosure; Discrimination; Disease; Drug usage; Enrollment; Epidemic; Equipment and supply inventories; Ethnic Origin; Exposure to; Facility Accesses; Family member; Friends; Green space; HIV; HIV Infections; Health; Health care facility; Home environment; Homophobia; Income; Individual; Intervention; Interview; Investigation; Longitudinal Studies; Mediating; Medical; Methods; Neighborhoods; New York City; Not Hispanic or Latino; Outcome; Overdose; Participant; Pathway interactions; Patients; Perception; Pharmaceutical Preparations; Pharmacy facility; Phase; Play; Poverty; Prevention; Race; Research; Resources; Risk Behaviors; Sexual Partners; Social Disorganizations; Social Network; Social Work; Social support; Socialization; Structure; Testing; Time; Violence; Viral; Viral Load result; Visit; Work; alcohol and other drug; antiretroviral therapy; base; behavioral outcome; black men who have sex with men; density of AOD outlets; design; falls; improved; innovation; member; men who have sex with men; multilevel analysis; prevention service; programs; racial discrimination; racial disparity; segregation; social; social norm; social stigma; statistics; theories; therapy adherence; trend; urban planning

Men who have sex with men (MSM) are highly impacted by HIV in the U.S. Marked disparities by race/ethnicity exist in HIV infection rates and engagement and retention in care along the HIV care continuum. Higher HIV acquisition rates among Black MSM are not fully explained by individual-level risk behaviors, while lower engagement and retention in care are exacerbated by factors that extend beyond the individual. In order to develop comprehensive, multi-level interventions to improve completion of steps along the HIV care continuum for Black and White MSM, it is critical to understand the mechanisms in which neighborhoods and social and sexual networks influence retention in care, antiretroviral therapy (ART) adherence, and viral suppression, and ascertain how these pathways differ by race/ethnicity. Using a socioecological theoretical framework, we propose to identify neighborhood-and network-level characteristics associated with HIV care outcomes among Black, non-Hispanic and White, non-Hispanic HIVinfected MSM in New York City (NYC) in a longitudinal study. We will focus on 3 potential neighborhoods of influence: home, social, and health facility access neighborhoods. We will investigate the influence of 4 neighborhood-level characteristic domains: (1) community violence, physical disorder, and social disorganization; (2) neighborhood alcohol and other drug (AOD) use-associated factors; (3) neighborhood-level social norms; (4) community resources. In this proposal, we will explore the following Specific Aims: Aim 1: To use spatial analysis to characterize clustering and spatial trends in HIV care outcomes (retention in care, ART adherence, and viral suppression) among Black and White HIV-infected MSM in NYC. Aim 2: To examine HIV care outcomes by race/ethnicity among Black and White HIV-infected MSM in NYC in relationship to longitudinal changes in: 2A. Exposure to neighborhoods of potential influence (home, social, health facility access). 2B. Neighborhood characteristics in four conceptual domains (community violence/physical disorder/social disorganization, neighborhood AOD use-associated factors, neighborhood-level social norms, community resources). 2C. Social and sexual networks. Aim 3: To use multilevel modeling to assess associations among changes over time in exposure to the 4 neighborhood characteristic domains and changes in social and sexual networks with HIV care outcomes by race/ethnicity, while assessing the potential mediating effects of individual- and network-level factors. The study will employ an innovative approach combining geospatial mapping of neighborhoods with methods from the field of spatial statistics and an existing, extensive geospatial database. The study will have direct implications for the design of neighborhood- and network-level interventions to improve the HIV care continuum for MSM, particularly for Black MSM.

在美国，男男性行为者（MSM）受到艾滋病毒的高度影响。 存在于艾滋病毒感染率以及参与和保持沿着艾滋病毒护理连续体的护理中。艾滋病毒感染率较高 黑人男男性接触者的获得率不能完全用个人层面的风险行为来解释， 超出个人范围的因素加剧了参与和保留护理的情况。为了 制定全面的、多层次的干预措施，以改善艾滋病毒护理连续体沿着步骤的完成情况 对于黑人和白色男男性接触者来说，理解社区和社会以及 性网络影响护理的保留、抗逆转录病毒治疗（ART）的坚持和病毒抑制， 确定这些途径如何因种族/民族而异。 使用社会生态学的理论框架，我们建议确定邻里和网络水平 黑人、非西班牙裔和白色、非西班牙裔HIV感染者中与HIV护理结果相关的特征 在纽约市（NYC）的男男性接触者的纵向研究。我们将重点关注3个潜在的社区， 影响：家庭、社会和卫生设施进入社区。我们将研究4的影响 社区层面的特征领域：（1）社区暴力、身体障碍和社会 （2）社区酒精和其他药物（AOD）使用相关因素;（3）社区水平 社会规范;（4）社区资源。在本提案中，我们将探讨以下具体目标： 目的1：使用空间分析来描述艾滋病毒护理结果的聚类和空间趋势（保留在 护理、ART依从性和病毒抑制）在纽约市黑人和白色HIV感染的男男性行为者中。 目的2：研究纽约市黑人和白色艾滋病毒感染的男男性行为者的种族/民族艾滋病毒护理结果， 与纵向变化的关系： 2A.接触潜在影响的社区（家庭、社会、医疗设施）。 2B.四个概念领域的邻里特征（社区暴力/身体障碍/社会 组织解体，邻里AOD使用相关因素，邻里社会规范，社区 资源）。 2C.社交和性网络。 目标3：使用多水平建模来评估暴露于4种物质随时间变化之间的关联 社区特征领域和社会和性网络的变化与艾滋病毒护理结果， 种族/民族，同时评估个人和网络层面因素的潜在中介作用。 这项研究将采用一种创新的方法，将社区的地理空间映射与方法相结合， 从空间统计领域和现有的广泛的地理空间数据库。该研究将直接 社区和网络级干预措施的设计，以改善艾滋病毒护理的影响 对MSM来说，尤其是对黑人MSM来说。