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

在美国，男男性行为者(MSM)受艾滋病毒的影响很大。种族/民族差异显著 在艾滋病毒护理连续统一体中，艾滋病毒感染率、参与度和保留率都存在差异。更高的艾滋病病毒 黑人MSM的获得率不能完全用个人层面的危险行为来解释，尽管较低 超出个人范围的因素加剧了对护理的投入和保留。为了 制定全面的、多层次的干预措施，以促进完成艾滋病毒护理连续过程中的各个步骤 对于黑人和白人MSM来说，了解社区和社会以及 性网络影响护理中的保留、抗逆转录病毒治疗(ART)的坚持和病毒抑制，以及 确定这些途径因种族/民族不同而有何不同。 利用社会生态学的理论框架，我们建议确定邻居和网络层面 黑人、非西班牙裔和白人非西班牙裔HIV感染者中与艾滋病毒护理结果相关的特征 纽约市男男性接触者(NYC)的一项纵向研究。我们将重点关注3个潜在的社区 影响：家庭、社交和卫生设施可进入社区。我们将调查4个因素的影响 邻里层面的特征领域：(1)社区暴力、身体紊乱和社交 无组织；(2)邻里酒精和其他毒品(AOD)使用相关因素；(3)邻里层面 社会规范；(4)社区资源。在这项建议中，我们将探讨以下具体目标： 目标1：使用空间分析来描述HIV护理结果的聚集性和空间趋势(保留在 护理、抗逆转录病毒治疗和病毒抑制)在纽约市的黑人和白人感染艾滋病毒的男男性行为者中。 目标2：按种族/民族检查纽约市黑人和白人感染艾滋病毒的男男性行为者的艾滋病毒护理结果 与以下方面的纵向变化的关系： 2a.接触可能产生影响的社区(家庭、社会、卫生设施通道)。 2B。四个概念领域(社区暴力/身体障碍/社会)的邻里特征 无组织，邻里使用相关因素，邻里层面的社会规范，社区 资源)。 2C。社交和性爱网络。 目标3：使用多水平建模来评估暴露于4种病毒的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/族裔，同时评估个人和网络层面因素的潜在中介影响。 这项研究将采用一种创新的方法，将社区的地理空间制图与方法相结合 来自空间统计领域和一个现有的、广泛的地理空间数据库。这项研究将直接 社区和网络一级干预措施的设计对改善艾滋病毒护理的影响 MSM的连续体，特别是黑人MSM。

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.