Drive to Zero: Developing a digital cohort to understand the drivers of non-sustained viral suppression in the Deep South

驱向零：开发数字队列以了解南方腹地非持续病毒抑制的驱动因素

• 批准号: 10675270
• 负责人: David S Batey
• 金额: $ 127.31万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675270
• 关键词: 18 year old; Address; Adherence; Age; Alabama; Area; Automobile Driving; Caring; Case Study; Censuses; Centers for Disease Control and Prevention (U.S.); Characteristics; Collaborations; Communities; Continuity of Patient Care; Country; Data; Data Collection; Data Reporting; Databases; Deep South; Dependence; Diagnosis; Elements; Eligibility Determination; Enrollment; Epidemic; Epidemiology; Exclusion; Feedback; Foundations; Funding; Future; Geography; Goals; HIV; HIV diagnosis; HIV/AIDS; Health; Health behavior; Healthcare; Heterogeneity; Incidence; Individual; Inequality; Inequity; Infection; Information Systems; Insurance; Intervention; Interview; Laws; Link; Louisiana; Low income; Measures; Mediator; Methods; Mississippi; Mobile Health Application; Modeling; Morbidity - disease rate; Newly Diagnosed; Outcome; Participant; Persons; Policies; Poverty; Public Health; Qualitative Methods; Racial Segregation; Rana; Reporting; Research; Resources; Role; Sampling; Self Management; Social Work; Standardization; Surveys; System; Technology; Testing; Time; U-Series Cooperative Agreements; United States; Viral; Viral Load result; Work; antiretroviral therapy; cohort; community based participatory research; cost; digital; epidemiology study; ethnic minority population; evidence base; experience; follow-up; health care availability; health management; improved; improved outcome; lens; mHealth; member; mortality; population health; primary outcome; prospective; prototype; psychosocial; racial minority population; recruit; residence; response; service providers; social; social stigma; social structure; structural determinants; surveillance data; systems research; therapy adherence; therapy development; transmission process; treatment services; trend; usability

PROJECT SUMMARY A combination of individual-, network-, community-, and structural-level variables impact all steps in the HIV Care Continuum, particularly in the Deep South states of Alabama (AL), Louisiana (LA), and Mississippi (MS), which disproportionately bear the nation's HIV burden while simultaneously having the fewest healthcare resources. While the individual-level correlates of viral suppression (VS) are well-known, few epidemiologic studies, especially those that are digitally-based, have examined VS from a multilevel lens that accounts for the role of geographic and community-level characteristics germane to the Deep South, such as aggregate poverty measures, racial segregation, and healthcare access. Epidemiological studies also typically exclude people with HIV (PWH) with non-sustained VS (non-VS) or without recent HIV labs, as these are among the hardest to identify and reach due to their limited healthcare involvement. Our highly experienced study team will address these research gaps through the proposed UG3-UH3 study, which will use mHealth technology to optimally recruit, screen, enroll, and retain a prospective digital cohort of 1000 PWH in AL, LA, and MS with non-VS or who otherwise lack evidence of having been in care for the previous 12 months, leveraging long-standing relationships with public health departments in each of these three states. We will assemble a community advisory board (CAB), consisting of PWH, health department partners, and HIV care team members in the three states and we will use the Information System Research (ISR) Framework to tailor features of an existing adherence management app for PWH, WiseApp. We will test usability of the Drive to Zero app prototype with PWH and informaticians. Eligible cohort participants will be PWH ages ≥18 years, living in AL, LA, or MS, living with HIV for ≥12 months, and entered in the Enhanced HIV/AIDS Reporting System (eHARS), a standardized document-based surveillance database used by all state health departments to report diagnosis and outcomes, with a recorded VL≥200 c/mL ≤12 months or have missing HIV lab values during that same period. Participants will be followed for three years with iterative annual psychosocial quantitative survey assessments conducted via the Drive to Zero app to assess predictors, mediators, and moderators for non-VS. We will contextualize quantitative data by using geospatial analysis, linking participant residence addresses at time of enrollment to Census tract data. Participants of the digital cohort (n=45) will also be eligible to participate in qualitative in-depth interviews to contextualize quantitative results. The findings from this study will inform efforts to recruit large, digital cohorts of PWH and will be among the first to demonstrate effective methods of retaining digital cohorts for HIV as well as other health conditions. Study findings will also help identify multilevel factors that contribute to non-VS in the Deep South, thereby elucidating future areas for intervention, and will directly lead to a follow- up R-level application.

项目总结 个人、网络、社区和结构层面的变量组合影响艾滋病毒护理的所有步骤 连续体，特别是在阿拉巴马州(AL)、路易斯安那州(LA)和密西西比州(MS)的南部腹地， 不成比例地承担着国家的艾滋病毒负担，同时拥有最少的医疗资源。 虽然病毒抑制(VS)与个体水平的相关性是众所周知的，但很少有流行病学研究， 尤其是那些基于数字的，已经从多层次透镜检查了VS，这解释了 与南方腹地密切相关的地理和社区特征，如总体贫困 措施、种族隔离和医疗保健服务。流行病学研究通常也排除了患有 有非持续性VS(非VS)的HIV(PWH)或没有最近的HIV实验室，因为这些是最难 由于他们在医疗保健方面的参与有限，因此确定并接触到他们。我们经验丰富的研究团队将致力于 这些研究差距通过拟议的UG3-UH3研究，该研究将使用mHealth技术来优化 招募、筛选、登记并保留AL、LA和MS中具有非VS或 其他方面缺乏在过去12个月内接受过护理的证据，利用长期 与这三个州的公共卫生部门的关系。我们将组建一个社区 顾问委员会(CAB)，由威尔斯亲王医院、卫生部门合作伙伴和三个部门的艾滋病毒护理团队成员组成 国家和我们将使用信息系统研究(ISR)框架来定制现有的 适用于PWH的遵从性管理应用WiseApp。我们将使用以下工具测试Drive to Zero应用程序原型的可用性 威尔斯亲王和信息学家。符合条件的队列参与者将是Pwh年龄≥18岁，居住在AL、LA或MS，居住 感染艾滋病毒12个月，并进入增强的艾滋病毒/艾滋病报告系统(≥)，这是一个标准化的 所有州卫生部门都使用基于文件的监测数据库来报告诊断和结果， 有记录的VL≥200c/mLHIV12个月或在同一时期内有缺失的≤化验值。参与者 将进行为期三年的重复年度心理社会定量调查评估 通过Drive to Zero应用程序评估非VS的预测者、调解人和主持人。我们将结合实际情况 使用地理空间分析的量化数据，将注册时的参与者住址链接到 人口普查区域数据。数字队列的参与者(n=45)也将有资格参加深入的定性研究 访谈将量化结果与背景联系起来。这项研究的发现将为招聘大型、 威尔斯亲王医院的数字队列，并将是首批展示留住数字队列的有效方法之一 艾滋病毒以及其他健康状况。研究结果还将有助于确定多层次的因素 对南方腹地的非VS，从而阐明了未来需要干预的领域，并将直接导致以下情况- 向上R级应用程序。