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

摘要 结束美国艾滋病流行的关键战略之一是增加对艾滋病的投资。 地理热点或疾病负担加重的地区。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提供信息。首先，热点映射通常使用住宅地址 一个偶然感染的人然而，对许多人来说，潜在的危险性行为和吸毒行为 不要在家里发生。确定风险发生的地点，而不是 参与风险生活的人，将有助于有针对性地采取干预措施，并增加对这些措施的接触。二是个别 行为通常受到更大的社会生态因素的约束或支配，这些因素可以共同作用， 造成或维持健康差距。针对风险热点采取干预措施，以改善艾滋病毒护理级联 需要对热点的更广泛的社会生态背景作出反应。第三，隐含的假设 关于优先考虑热点干预措施的一个重要问题是，减少热点地区发病率的努力将间接减少 其他地方的发病率也很高，因为感染可能从高发地区蔓延到邻近的低发地区。 流行区。关于热点之间潜在的地理和性网络连接的信息， 其他地方可以为艾滋病毒干预措施确定风险热点的优先次序提供信息。 我们将展示创新方法，以确定和优先考虑城市，非白人， 男男性行为者（MSM）是美国艾滋病毒感染的高危人群。我们将 利用和补充现有的关于非白人男男性行为者（包括艾滋病毒感染者和未感染者）的纵向数据， 正在洛杉矶进行的mStudy队列研究，以实现我们的目标。我们将首先调整现有的基于Web的 对艾滋病毒风险和预防活动进行空间调查，以纳入网络的地理特征， 居住地的流动性和吸毒地点。然后我们将使用认知访谈来验证调查结果 仪器，并收集数据，从250男男性接触者使用更新的调查。其次，我们将识别和描述 使用个人活动空间数据的洛杉矶县内HIV传播和获得风险热点 关于性风险和吸毒地点，热点地区的邻里特征，以及社会人口统计学 在热点地区从事风险活动的个人的特征和行为。第三，我们估计 热点到其它位置的连通性（例如，其他热点、居住地和预防地）， 以确定优先考虑哪个热点，从而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、护理和治疗战略的有效性。一是 将指导决策，优先考虑哪个热点，通过对它们的潜在连接性进行排名， 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 通过确定热点的背景和组成，干预措施将是最成功的。

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.