Activity spaces for HIV risk and prevention among diverse men who have sex with men in Los Angeles

洛杉矶不同男男性行为者的艾滋病毒风险和预防活动空间

• 批准号: 10201551
• 负责人: SUSAN LYNN CASSELS
• 金额: $ 18.12万
• 依托单位: UNIVERSITY OF CALIFORNIA SANTA BARBARA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10201551
• 关键词: AIDS prevention; Address; African American; Area; Behavior; Behavioral; Caring; Censuses; Characteristics; County; Data; Decision Making; Diagnosis; Drug usage; Effectiveness; Effectiveness of Interventions; Epidemic; Exposure to; Geography; Goals; HIV; HIV diagnosis; HIV risk; Home; Incidence; Individual; Infection; Intervention; Investments; Latinx; Link; Location; Logistic Regressions; Los Angeles; Low Prevalence; Measures; Methods; Modeling; Neighborhoods; Online Systems; Physical environment; Policies; Population; Prevention; Race; Residential Mobility; Risk; Role; Sampling; Sexual Health; Social Environment; Surveys; Time; United States; Update; Viral Load result; Work; aged; base; black men who have sex with men; burden of illness; cognitive interview; cohort; data space; drug use behavior; geographic risk; health disparity; health seeking behavior; high risk; improved; innovation; men; men who have sex with men; metropolitan; pre-exposure prophylaxis; preference; racial and ethnic; racial minority; response; sex; social space; sociodemographics; substance use; transmission process; treatment strategy

Abstract One of the key strategies to ending the HIV epidemic in the United States is to increase investments in geographic hotspots, or areas of elevated disease burden. However, a few key challenges limit the ability for hotspot mapping to inform effective HIV interventions. First, hotspot mapping typically uses residential address of an individual with an incident infection. Yet for many individuals, potential risky sex and drug-use behaviors do not occur at home. Identifying the places in which risk occurs, as opposed to where an individual who engages in risk lives, will help target and increase exposure to place-based interventions. Second, individual behavior is often constrained or dictated by larger socio-ecological factors, and these can work together to create or maintain health disparities. Interventions tailored to risk hotspots to improve the HIV care cascade need to be responsive to the broader socio-ecological context of the hotspot. Third, an implicit assumption about prioritizing hotspots for interventions is that efforts to reduce incidence in hotspots will indirectly reduce incidence elsewhere as well, as infections likely spread from high incidence areas to neighboring lower prevalence areas. Information on potential geographic and sexual network connectivity between hotspots and other places can inform prioritization of risk hotspots for HIV interventions. We will demonstrate innovative methods to identify and prioritize HIV risk hotspots among urban, non-white men who have sex with men (MSM), populations at especially high-risk for HIV in the United States. We will leverage and supplement existing longitudinal data on non-White MSM, both HIV-infected and uninfected, from the ongoing mStudy cohort in Los Angeles, to achieve our goals. We will first adapt an existing web-based activity space survey of HIV risk and prevention to incorporate geographic characteristics of networks, residential mobility, and locations of drug use. Then we will use cognitive interviews to validate the survey instrument, and collect data from 250 MSM using the updated survey. Second, we will identify and describe HIV transmission and acquisition risk hotspots within Los Angeles County, using individual activity space data on sexual risk and drug use locations, neighborhood characteristics of the hotspots, and sociodemographic characteristics and behaviors of individuals engaging in risk in the hotspots. Third, we will estimate connectivity of hotspots to other locations (e.g., other hotspots, residential locations, and prevention locations), in order to identify which hotspot to prioritize for maximizing intervention effectiveness over time and space. This work will improve the effectiveness of HIV prevention, care, and treatment strategies in two ways. First, it will guide decision making as to which hotspot to prioritize, by ranking them in terms of potential connectivity to other places, and thus maximizing the reach of the intervention. Second, it will inform which combination of interventions will be most successful, by characterizing the context and composition of the hotspot.

抽象的 结束美国艾滋病毒流行的关键策略之一是增加对艾滋病毒的投资 地理热点或疾病负担高的地区。然而，一些关键挑战限制了 热点绘图，为有效的艾滋病毒干预措施提供信息。首先，热点映射通常使用住宅地址 发生意外感染的个人。然而对于许多人来说，潜在的危险性行为和吸毒行为 不会发生在家里。识别风险发生的地方，而不是个人发生风险的地方 参与风险生活，将有助于瞄准并增加基于地点的干预措施。二、个人 行为往往受到更大的社会生态因素的限制或决定，这些因素可以共同作用 造成或维持健康差异。针对风险热点量身定制的干预措施，以改善艾滋病毒护理级联 需要对热点地区更广泛的社会生态背景做出反应。三、隐含假设 优先考虑热点地区的干预措施是，减少热点地区发病率的努力将间接减少 其他地区的发病率也很高，因为感染可能从高发地区传播到邻近的低发地区 流行地区。有关热点和地区之间潜在的地理和性网络连接的信息 其他地方可以告知艾滋病毒干预措施的风险热点的优先顺序。 我们将展示创新方法来识别和优先处理城市、非白人中的艾滋病毒风险热点 男男性行为者 (MSM)，是美国感染艾滋病毒的高危人群。我们将 利用和补充关于非白人男男性接触者（包括艾滋病毒感染者和未感染者）的现有纵向数据 洛杉矶正在进行的 mStudy 队列，以实现我们的目标。我们将首先调整现有的基于网络的 艾滋病毒风险和预防的活动空间调查，纳入网络的地理特征， 居住流动性和吸毒地点。然后我们将使用认知访谈来验证调查 仪器，并使用更新的调查从 250 MSM 收集数据。其次，我们将识别并描述 使用个人活动空间数据确定洛杉矶县内的艾滋病毒传播和感染风险热点 关于性风险和吸毒地点、热点地区的社区特征以及社会人口统计 在热点地区从事风险活动的个人的特征和行为。第三，我们将估计 热点与其他位置的连接（例如其他热点、住宅位置和预防位置）， 以确定优先考虑哪些热点，以在时间和空间上最大限度地提高干预效果。 这项工作将从两个方面提高艾滋病毒预防、护理和治疗策略的有效性。首先，它 将根据潜在的连接性对热点进行排名，从而指导优先考虑哪个热点的决策 其他地方，从而最大限度地扩大干预范围。其次，它将告知哪种组合 通过描述热点的背景和构成，干预措施将取得最大成功。