Geographic Variability in Time from HIV Diagnosis to Viral Suppression in the Deep South: A Roadmap to Accelerated Treatment Initiation

南方腹地从艾滋病毒诊断到病毒抑制的时间地理差异：加速治疗启动的路线图

• 批准号: 10305677
• 负责人: David S Batey
• 金额: $ 42.75万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-12-24 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10305677
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; Age; Alabama; Area; Automobile Driving; Caring; Case Study; Characteristics; Cities; Clinical; Code; Collaborations; Communities; Continuity of Patient Care; Country; Data; Deep South; Development; Diagnosis; Epidemic; Evaluation; Funding; Geography; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Health Resources; Health system; Heterogeneity; Individual; International; Intervention; Interview; Investigation; Louisiana; Medicaid; Methods; Mississippi; Newly Diagnosed; Outcome; Patients; Persons; Population; Poverty; Provider; Public Health; Reporting; Research; Research Methodology; Research Personnel; Research Project Grants; Research Proposals; Resources; Social Work; System; Testing; Time; United States; United States National Institutes of Health; Universities; Viral; Virus Diseases; analytical tool; antiretroviral therapy; care outcomes; contextual factors; cost effective intervention; cost effectiveness; design; experience; health disparity; implementation cost; implementation trial; improved; improved outcome; informant; innovation; intervention program; novel; population health; programs; prototype; racial disparity; service providers; social stigma; socioeconomics; surveillance data; therapy development; transmission process; treatment services; underserved area

Project Abstract This proposal describes a 5-year research plan that seeks to address gaps in our understanding of the individual, geographic, and sociocontextual determinants of delays in achieving HIV viral suppression (VS) in the Deep South region of the United States (US), an area carrying a disproportionate burden of the country’s HIV epidemic. The proposal leverages a dynamic and innovative collaboration of experienced investigators from the University of Alabama at Birmingham (UAB) Center for AIDS Research (CFAR) and the HIV Divisions of the state health departments in Alabama (AL), Louisiana (LA), and Mississippi (MS). This novel research proposal utilizes a population-health approach to evaluate time to VS among newly diagnosed individuals and integrates a mixed-methods approach to examine the socioeconomic, demographic, and structural determinants of time to VS in this population in the development of an intervention to accelerate initiation of antiretroviral therapy (ART). The specific aims of this proposal are to: 1) Utilize HIV surveillance data collected by the states’ public health electronic HIV/AIDS Reporting System (eHARS) to characterize geographic variability in time from HIV diagnosis to VS (<200 c/mL) among newly reported HIV cases among those age ≥13 years at diagnosis between January 2014-December 2017 in AL, LA, and MS; 2) Identify individual and community-level determinants of time to VS, incorporating quantitative geospatial coding methods, in AL, LA, and MS among newly reported cases of HIV among those age ≥13 years at diagnosis from January 2014-December 2017 and contextualize these findings with qualitative key informant interviews among persons living with HIV (PLWH), HIV treatment and social services providers, and other community stakeholders in AL, LA, and MS; and 3) Engage stakeholders in developing a rapid ART initiation program focusing upon localities in the Deep South with disproportionately longer time from HIV diagnosis to VS. We will then incorporate these results in an R01 application testing the implementation of a community-level rapid ART initiation program in the Deep South, focusing on areas with longer time from HIV diagnosis to VS. Results of this research will lay the groundwork for a larger implementation trial that will include rigorous evaluation of interventions integrating clinical and public health systems aimed at improving time to VS in the US with consideration for cost-effectiveness.

项目摘要 该建议描述了一项为期5年的研究计划，试图解决我们的理解中的差距 在实现HIV病毒中的个人，地理和社会上下文的确定词中 美国深南部地区的抑制（Vs）（美国），一个带有A的区域 该国艾滋病毒流行病的伯宁不成比例。该提议利用了动态和 阿拉巴马大学经验丰富的调查员的创新合作 伯明翰（UAB）艾滋病研究中心（CFAR）和国家卫生的HIV部门 阿拉巴马州（AL），路易斯安那州（LA）和密西西比州（MS）的部门。这项新颖的研究建议 利用人群健康方法评估新诊断的个体的时间 并整合了混合方法的方法，以检查社会经济，人口统计学和 在开发干预措施中，该人群中时间的结构决定者 加速抗逆转录病毒疗法（ART）的倡议。该提议的具体目的是：1） 利用各州公共卫生电子艾滋病毒/艾滋病报告收集的艾滋病毒监测数据 系统（EHARS）表征从HIV诊断到vs的时间的地理变异性（<200） C/ml）在新报告的HIV病例中，在诊断时≥13岁。 2014年1月至12月，2017年在AL，LA和MS； 2）确定个人和社区级别 vs的时间决定因素，在AL，LA和 从一月份开始诊断为≥13岁的新报告的HIV病例中的MS 2014年12月至2017年，并通过定性关键线人访谈将这些发现与这些发现相关。 在艾滋病毒（PLWH），艾滋病毒治疗和社会服务提供者以及其他人中 AL，LA和MS的社区利益相关者； 3）让利益相关者迅速发展 艺术倡议计划着重于深南地区的地区，不成比例的时间更长 从HIV诊断到VS的时间然后，我们将这些结果纳入R01应用程序测试 在深南部的社区级快速艺术计划计划的实施，重点 在从HIV诊断到VS的时间更长的地区这项研究的结果将是 大型实施试验的基础工作，其中包括严格评估干预措施 整合临床和公共卫生系统，旨在通过 考虑成本效益。