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

纽约市感染 HIV 的 MSM 的社区、网络和 HIV 护理连续体

• 批准号: 9920215
• 负责人: Hong Van Nhu Tieu
• 金额: $ 85.99万
• 依托单位: NEW YORK BLOOD CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9920215
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Age; Alcohols; Area; Award; Biological; Caring; Characteristics; Communities; Conceptual Domain; Continuity of Patient Care; Crime; Data; Databases; Disadvantaged; Disclosure; Disease; Drug usage; Enrollment; Epidemic; Equipment and supply inventories; Ethnic Origin; Exposure to; Facility Accesses; Family member; Fostering; Friends; Funding; Green space; HIV; HIV Infections; Health; Health care facility; Hispanics; Home environment; Homophobia; Housing; Individual; Intervention; Investigation; Latino; Longitudinal Studies; Mediating; Medical; National Institute of Mental Health; Neighborhoods; New York City; Outcome; Overdose; Participant; Pathway interactions; Perception; Pharmaceutical Preparations; Pharmacy facility; Play; Policies; Poverty; Prevention; Psychological Theory; Race; Research; Resources; Role; Social Disorganizations; Social Network; Social Work; Social support; Socialization; Socioeconomic Status; Stress and Coping; Structure; Testing; Time; United States; United States National Institutes of Health; Violence; Viral; Viral Load result; Visit; Work; alcohol and other drug; antiretroviral therapy; base; behavioral outcome; care outcomes; design; improved; infection rate; innovation; member; men who have sex with men; multilevel analysis; prevention service; programs; racial and ethnic disparities; racial discrimination; racial disparity; resilience; segregation; social; social capital; social deficits; social norm; social stigma; statistics; theories; therapy adherence; trend; urban area; urban planning

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.

抽象的 艾滋病毒感染率以及护理中的敬业度和保留率存在于种族/种族中明显的差异 在与男性发生性关系（MSM）沿艾滋病毒护理连续体的男人中。与白色MSM相比 被感染的黑色和西班牙裔/拉丁裔MSM不太可能接受抗逆转录病毒疗法（ART），遵守艺术， 并实现病毒抑制。黑人和拉丁裔MSM的护理率和保留率较低 受个人以外因素的影响。为了发现邻里和网络参与的 在艾滋病毒护理结果中产生种族/种族差异的途径，为 干预措施和政策，以填补黑人和拉丁裔MSM的护理连续性空白，系统，理论 - 基于对与之相关的特定和相交的社区和网络特征的研究 必须聘请保留护理，艺术依从性和病毒抑制。 使用社会生态和交叉概念框架，几个中端和微社会 和心理理论，并由我们的NIH/NIMH R56资助的形成性研究所告知，我们建议 确定与HIV护理连续性结果相关的邻里和网络级别的特征（病毒 居住在纽约市的550名HIV感染的MSM中，抑制，保留和艺术依从性） （NYC）通过纵向研究。我们将研究邻里组成的影响和四个 邻里级特征领域，测试不同不同的影响理论途径 MSM居住，社交和接受艾滋病毒护理的社区。 在纽约市的HIV感染的MSM中，具体目的是： 目标1：使用空间分析来表征HIV护理结果中的聚类和空间趋势。 目标2：通过种族/种族与纵向变化的关系检查艾滋病毒的护理结果：2a） 暴露于潜在影响的社区（家庭；社会;医疗机构访问）； 2b）邻里 特征概念领域（社区暴力/身体障碍/社会混乱； 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随着时间的变化的关联 邻里特征和社交网络因种族/种族而具有艾滋病毒护理结果的社交网络变化，而 评估个体和网络级别因素的潜在中介和调节作用。 该研究将采用一种创新的方法，将社区的地理空间映射与 多级建模，空间统计以及现有的，广泛的地理空间数据库。它将有直接 对多层次干预措施的设计的影响，解决邻里，网络和网络的因素 个人级别，以改善MSM的艾滋病毒护理结果，特别是黑人和拉丁裔MSM。