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.

与男性发生性关系的男性（MSM）受到美国艾滋病毒的影响很大 存在于艾滋病毒感染率，参与度和保留率沿HIV护理连续体中。较高的艾滋病毒 黑色MSM的获取率并未通过个人级别的风险行为充分说明，而较低 范围超出了个人的因素，使参与和保留在护理方面受到加剧。为了 制定全面的多层干预措施，以改善沿艾滋病毒护理连续体的步骤的完成 对于黑白MSM，了解社区和社会和社会和社会的机制至关重要 性网络影响保留在护理中，抗逆转录病毒疗法（ART）依从性和抑制病毒，以及 确定这些途径如何因种族/种族而异。 使用社会生态学理论框架，我们建议确定邻里和网络级别 黑人，非西班牙裔和白色，非西班牙裔Hivincted的特征与HIV护理结果相关 纽约市的MSM在一项纵向研究中。我们将专注于3个潜在社区 影响力：家庭，社会和医疗机构访问社区。我们将研究4的影响 邻里级别的特征领域：（1）社区暴力，身体混乱和社会 混乱； （2）邻里酒精和其他药物（AOD）使用相关因素； （3）邻里级别 社会规范； （4）社区资源。在此提案中，我们将探讨以下特定目标： 目标1：使用空间分析来表征艾滋病毒护理结果的聚类和空间趋势（保留在 在纽约市的黑白HIV感染的MSM中，护理，艺术依从性和病毒抑制）。 目标2：在纽约市黑人和白人感染的艾滋病毒感染的MSM中，通过种族/种族来检查艾滋病毒的护理结果 与纵向变化的关系： 2a。接触潜在影响的社区（家庭，社会，医疗机构获取）。 2b。四个概念领域的邻里特征（社区暴力/身体障碍/社会 混乱，邻里AOD使用相关因素，邻里层面的社会规范，社区 资源）。 2C。社会和性网络。 目标3：使用多级建模来评估接触4的变化之间的关联 通过艾滋病毒护理结果的邻里特征领域和社会和性网络的变化 种族/种族，同时评估个体和网络级别因素的潜在中介作用。 该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结合在一起 从空间统计和现有的广泛地理空间数据库中。该研究将直接 对邻里和网络水平干预措施的设计的影响，以改善艾滋病毒护理 MSM的连续体，特别是黑色MSM。