The HIV Care Continuum and Health Policy: Changes through Context and Geography

项目摘要(摘要)。 HIV关怀连续体是一个令人信服的流行病学框架，描述了 艾滋病毒/艾滋病感染者的流动通过护理，包括诊断、联系和 保留护理，使用抗逆转录病毒治疗(ART)，并最终抑制病毒。健康状况 政策可能会对护理连续性的结果产生深远的影响，这些影响可能 可跨区域和通过单个上下文进行修改。 在观察性队列中，临床护理、抗逆转录病毒药物使用和病毒抑制中的保留 根据可获得的数据和研究中的人口，比例有所不同。美国 国家艾滋病毒/艾滋病战略(2020年更新)和经修订的2013年世界卫生组织 ART指南也参考了护理连续体中的里程碑。因为病人 《保护和平价医疗法案》(ACA)和其他北拉丁国家卫生政策 美洲国家的目标是改善医疗保健获得机会，减少健康差距，描述 在这些环境中，政策和背景因素对护理连续结果的影响是 引起流行病学家、临床医生和政策制定者的极大兴趣。 这项研究试图量化卫生政策、社会人口、背景和 HIV感染者连续护理结果的地理模式和相关因素 在美国、加拿大和墨西哥的人员。背景因素包括精神疾病 疾病，地区贫困，居住城市化，以及其他个人和环境 特点。北美艾滋病队列研究和设计合作(NA- 加勒比、中美洲和南美洲艾滋病毒流行病学网络 (CASAnet)为开展这项工作提供了丰富的数据来源。 目标1将量化北美和拉丁美洲连续护理结果的差异， 评估卫生系统、人口、风险、背景和地理差异。因为 情境因素和卫生系统特征对护理的影响研究 在具有临床护理数据的纵向队列中，连续结果是稀疏的或 由于地理位置的限制，这一分析将是新颖的，具有重要的意义。 目标2和目标3将提供关于ACA在改善医疗保健方面的效果的推论 在美国接受治疗的艾滋病毒感染者中。州政府主导的医疗补助覆盖面的扩大 根据ACA，将作为准实验来评估对护理连续性和 其他艾滋病毒疾病结果，比较ACA前(2014年前)和ACA执行期。

PROJECT SUMMARY (ABSTRACT). The HIV Care Continuum is a compelling epidemiologic framework describing the movement of people living with HIV/AIDS through care, including diagnosis, linkage and retention in care, use of antiretroviral therapy (ART), and ultimately, viral suppression. Health policies may profoundly influence outcomes along the Care Continuum, and these effects may be modified across regions and through individual contexts. In observational cohorts, retention in clinical care, ART use, and viral suppression proportions have varied depending on available data and the population under study. The US National HIV/AIDS Strategy (updated to 2020) and the revised 2013 World Health Organization ART guidelines also reference milestones in the Care Continuum. Because the Patient Protection and Affordable Care Act (ACA) and other national health policies in North and Latin American countries aim to improve healthcare access and reduce health disparities, describing the effect of policy and contextual factors on Care Continuum outcomes in these settings is of great interest to epidemiologists, clinicians, and policy makers. This research seeks to quantify health policy, sociodemographic, contextual, and geographic patterns and correlates of HIV Care Continuum outcomes among HIV-infected persons in the United States (US), Canada, and Mexico. Contextual factors include psychiatric illness, regional poverty, residential urbanicity, and other individual and environmental characteristics. The North American AIDS Cohort Collaboration on Research and Design (NA- ACCORD) and Caribbean, Central and South America network for HIV epidemiology (CCASAnet) provide rich data sources in which to conduct this work. Aim 1 will quantify disparities in Care Continuum outcomes in North and Latin America, assessing health system, demographic, risk, contextual, and geographic differences. Because research into the influence of contextual factors and health system characteristics on Care Continuum outcomes in longitudinal cohorts with clinical care data have been sparse or geographically limited, this analysis will be novel and of significant importance. Aims 2 and 3 will provide inferences about the ACA's effects on improving healthcare among HIV-infected individuals in care in the US. The state-led expansion of Medicaid coverage under the ACA will be used as a quasi-experiment to assess effects on Care Continuum and other HIV disease outcomes, comparing pre-ACA (pre-2014) to ACA implementation periods.