Neighborhoods, Networks, and the HIV Care Continuum among HIV-infected MSM in NYC

摘要 艾滋病毒感染率以及护理参与度和保留率存在明显的种族/族裔差异 艾滋病毒护理过程中的男男性行为者 (MSM)。与白人 MSM 相比，HIV- 受感染的黑人和西班牙裔/拉丁裔 MSM 接受抗逆转录病毒治疗 (ART) 的可能性较小，坚持 ART， 并达到病毒抑制的目的。黑人和拉丁裔男男性接触者的护理参与度和保留率较低 受到个人以外因素的影响。为了揭示涉及邻里和网络的 在艾滋病毒护理结果中产生种族/民族差异的途径，为以下方面提供了经验基础： 旨在填补黑人和拉丁裔 MSM 护理连续性空白的干预措施和政策，系统性、理论性 基于对与相关的特定和交叉邻域和网络特征的调查 必须坚持护理、坚持抗逆转录病毒治疗和病毒抑制。 使用社会生态学和交叉概念框架，一些中程和微观社会 和心理学理论，并根据 NIH/NIMH R56 资助的形成性研究，我们建议 确定与艾滋病毒护理连续结果相关的社区和网络层面的特征（病毒 生活在纽约市的 550 名感染 HIV 的 MSM 中的艾滋病毒抑制、保留护理和 ART 依从性） （纽约）通过纵向研究。我们将研究邻里组成和四个因素的影响 邻里层面的特征域，测试不同影响力的理论路径 MSM 居住、社交和接受 HIV 护理的社区。 对于纽约市感染 HIV 的 MSM，具体目标是： 目标 1：利用空间分析来描述 HIV 护理结果的聚类和空间趋势。 目标 2：按种族/民族检查 HIV 护理结果与以下方面纵向变化的关系：2a) 接触具有潜在影响力的社区（家庭、社交、医疗设施）； 2b) 邻里 特征 概念领域（社区暴力/身体障碍/社会解体；AOD 使用 因素；社会规范；社区资源）； 2c) 社交网络。 目标 3：使用多级建模来评估暴露于环境中随时间变化之间的关联 按种族/族裔划分的社区特征和社交网络中艾滋病毒护理结果的变化，同时 评估个人和网络层面因素的潜在中介和调节作用。 该研究将采用一种创新方法，将社区地理空间测绘与 多级建模、空间统计和现有的广泛的地理空间数据库。将会有直接的 对多层次干预措施设计的影响，解决邻里、网络和社区因素 个人层面，以改善 MSM 的艾滋病毒护理结果，特别是黑人和拉丁裔 MSM。

Abstract Marked disparities by race/ethnicity exist in HIV infection rates and engagement and retention in care among men who have sex with men (MSM) along the HIV care continuum. Compared with White MSM, HIV- infected Black and Hispanic/Latino MSM are less likely to be on antiretroviral therapy (ART), adhere to ART, and achieve viral suppression. Lower rates of care engagement and retention among Black and Latino MSM are influenced by factors beyond the individual. In order to uncover the neighborhood- and network-involved pathways that produce racial/ethnic disparities in HIV care outcomes, yielding an empirical basis for interventions and policies to fill gaps in the care continuum among Black and Latino MSM, systematic, theory- based investigation of the specific and intersecting neighborhood and network characteristics that relate to retention in care, ART adherence, and viral suppression must be engaged. Using socioecological and intersectional conceptual frameworks, several mid-range and micro social and psychological theories, and informed by our NIH/NIMH R56-funded formative research, we propose to identify neighborhood-and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and ART adherence) among 550 HIV-infected MSM living in New York City (NYC) via a longitudinal study. We will investigate the influence of neighborhood composition and four neighborhood-level characteristics domains, testing theoretical pathways of influence across the different neighborhoods in which MSM live, socialize, and receive HIV care. The Specific Aims are, among HIV-infected MSM in NYC: Aim 1: To use spatial analysis to characterize clustering and spatial trends in HIV care outcomes. Aim 2: To examine HIV care outcomes by race/ethnicity in relationship to longitudinal changes in: 2a) Exposure to neighborhoods of potential influence (home; social; health facility access); 2b) Neighborhood characteristics conceptual domains (community violence/physical disorder/social disorganization; AOD use factors; social norms; community resources); 2c) Social networks. Aim 3: To use multilevel modeling to assess associations among changes over time in exposure to the neighborhood characteristics and changes in social networks with HIV care outcomes by race/ethnicity, while assessing the potential mediating and moderating effects of individual- and network-level factors. The study will employ an innovative approach combining geospatial mapping of neighborhoods with multilevel modeling, spatial statistics, and an existing, extensive geospatial database. It will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood-, network-, and individual-levels, to improve HIV care outcomes for MSM, particularly for Black and Latino MSM.