WHERE TO INTERVENE? GEOSPATIAL VARIATION OF HIV TRANSMISSION BEHAVIORS

在哪里进行干预？

• 批准号: 8063811
• 负责人: ENBAL SHACHAM
• 金额: $ 3.8万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8063811
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Affect; African American; Alcohol consumption; Alcohols; Area; Behavior; Caring; Censuses; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic Disease; Cities; Clinic; Code; Communicable Diseases; Communities; Data; Development; Drug usage; Effectiveness; Environment; Environmental Risk Factor; Evidence based intervention; Frequencies; Funding; Geographic Distribution; Geographic Information Systems; Geographic Locations; HIV; HIV Infections; HIV diagnosis; Health; Heavy Drinking; Home environment; Illicit Drugs; Incidence; Individual; Infection; Intervention; Interview; Life; Low income; Marketing; Mass Media; Modeling; Natural History; Needle Sharing; Neighborhoods; Outcome; Pattern; Population; Prevalence; Prevention; Public Health; Reporting; Research; Risk Behaviors; Risk Reduction; Role; Sampling; Secondary Prevention; Sex Behavior; Sexually Transmitted Diseases; Site; Smoke; Smoking; Variant; Workplace; base; behavior change; billboard; density; effective intervention; effective therapy; epidemiologic data; evidence base; geographic difference; high risk behavior; high risk sexual behavior; improved; low socioeconomic status; metropolitan; mortality; multilevel analysis; prevent; public health relevance; sex risk; smoking cessation; socioeconomics; statistics; success; transmission process; urban area

DESCRIPTION (provided by applicant): HIV is becoming more of a chronic disease to manage with continuing treatment advancements. While this is particularly encouraging, it poses increased opportunities for HIV transmission, due to individuals living longer with the infectious disease. The development of evidence-based interventions for populations with HIV to reduce new infections has been somewhat limited in scope, and very few of those interventions have incorporated the environment in which individuals live as a determinant of high-risk behaviors. Individual behavior change seems additionally challenging to sustain considering the environmental factors in which a large proportion of individuals with HIV live; as has been found in smoking cessation, where individuals are more successful when worksite and home smoking bans are in effect. Alcohol and illicit drug use have been shown to be proximally and distally related to HIV transmission and sexually transmitted infections (STI) due to unplanned and unprotected sexual behavior as well as needle sharing or sharing pipes with open sores among drug use partners. Higher rates of alcohol use have been associated in neighborhoods with higher density of alcohol-selling establishments as well as marketing of alcohol using billboards. Types and frequency of drug use and rates of STIs have been shown to vary by neighborhood. Furthermore, there have been few studies that found faster HIV progression occurring in low-income neighborhoods. Sexual behaviors have been found to be less risky after HIV diagnosis; yet STI incidence rates continue, which urges the need for improved prevention efforts. Engagement in high-risk behaviors is clearly continuing among individuals with HIV and more effective interventions are necessary to stop the transmission of HIV. Individual- level risk reduction efforts have not yet been broadly successful. Finding neighborhood factors that influence high risk behaviors among individuals with HIV may help develop appropriate interventions. This study aims to examine the geographic distribution of illicit drug using behaviors, alcohol consumption, and sexual risk behaviors among individuals with HIV in 4 U.S. metropolitan areas across 7 different HIV clinics. These findings will also reveal opportunities for neighborhood-based interventions aimed to reduce HIV transmission. This study is being proposed as an opportunity to repurpose data from the established Centers for Disease Control and Prevention (CDC)-funded multi-site Study to Understand the Natural History of HIV and AIDS in the Era of Effective Therapy. Specifically, this study aims to: (1) develop a multilevel model of risk behaviors (illicit drug and alcohol use, sexual behaviors) among 700 individuals with HIV in a multi-city (St. Louis, MO; Minneapolis, MN; Denver, CO; and Providence, RI) sample using individual interviews and GIS, and (2) develop a spatial model of high-risk behavior environments among individuals with HIV in the 4 metropolitan areas that can explain geographic differences high-risk behaviors among individuals with HIV and identify areas where interventions could be implemented. PUBLIC HEALTH RELEVANCE: This study aims to assess the role of the neighborhood on engagement in high-risk behaviors, including illicit drug and alcohol use and unprotected sexual behaviors as they contribute to the transmission of HIV. We have proposed a study that represents a sample of individuals with HIV who are engaged in care in 4 U.S. metropolitan areas across 7 clinics. Prevention efforts in the U.S. have had limited effectiveness, with consistent rates of HIV incident cases annually. Understanding the environmental context in which HIV transmission behaviors occur among infected populations will enhance the opportunities to identify new and appropriate areas of intervention to prevent HIV transmission. These findings will impact clinic practices and overall HIV prevention efforts in the U.S.

描述（由申请人提供）：随着治疗的不断进步，艾滋病毒越来越成为一种慢性疾病。虽然这一点特别令人鼓舞，但由于感染艾滋病毒的人寿命更长，这增加了艾滋病毒传播的机会。为艾滋病毒感染者制定循证干预措施以减少新感染的范围有限，而且这些干预措施很少将个人生活的环境作为高危行为的决定因素。 考虑到大部分艾滋病毒感染者所处的环境因素，个人行为改变似乎更具有挑战性;正如在戒烟中发现的那样，当工作场所和家庭禁烟时，个人更成功。酒精和非法药物的使用已被证明与艾滋病毒传播和性传播感染（STI）的近端和远端相关，这是由于无计划和无保护的性行为以及吸毒伙伴之间共用针头或共用带有开放性溃疡的管道。酒精使用率较高与酒精销售机构密度较高以及使用广告牌销售酒精的社区有关。毒品使用的类型和频率以及性传播感染的比率已被证明因社区而异。此外，很少有研究发现艾滋病毒在低收入社区的发展速度更快。在艾滋病毒诊断后，性行为的风险已被发现较低;但性传播感染的发病率仍在继续，这就迫切需要加强预防工作。艾滋病毒感染者显然继续从事高风险行为，必须采取更有效的干预措施来阻止艾滋病毒的传播。个人层面的降低风险努力尚未取得广泛成功。找到影响艾滋病毒感染者高危行为的邻里因素可能有助于制定适当的干预措施。本研究旨在研究美国4个大都市地区7个不同HIV诊所的HIV感染者非法药物使用行为、饮酒和性风险行为的地理分布。这些发现还将揭示旨在减少艾滋病毒传播的社区干预措施的机会。这项研究被提议作为一个机会，重新利用来自疾病控制和预防中心（CDC）资助的多地点研究的数据，以了解有效治疗时代艾滋病毒和艾滋病的自然史。具体而言，本研究旨在：（1）建立风险行为的多层次模型（非法药物和酒精使用，性行为）在一个多城市的700名艾滋病毒感染者中（密苏里州圣路易斯;明尼苏达州明尼阿波利斯;科罗拉多州丹佛;和普罗维登斯，RI）样本使用个人访谈和GIS，和（2）在4个大都市地区的艾滋病毒感染者中建立一个高风险行为环境的空间模型，该模型可以解释高风险行为的地理差异，艾滋病毒感染者的危险行为，并确定可以实施干预措施的领域。 公共卫生相关性：这项研究旨在评估社区在参与高风险行为方面的作用，包括非法药物和酒精使用以及无保护的性行为，因为它们有助于艾滋病毒的传播。我们提出了一项研究，代表了在美国4个大都市地区7个诊所从事护理的艾滋病毒感染者的样本。美国的预防工作效果有限，每年的艾滋病毒事件发生率一直保持不变。了解感染人群中发生艾滋病毒传播行为的环境背景将增加确定新的适当干预领域以预防艾滋病毒传播的机会。这些发现将影响美国的诊所实践和整体艾滋病预防工作。