Leveraging data to identify opportunities to address insecure care connections and poor health outcomes among people living with HIV

总结/摘要 为了确定艾滋病毒感染者（PLWH）中艾滋病毒结果较差与良好的相关性，研究人员 专注于临床数据。因此，对非临床相关性和迁移的理解有限 艾滋病毒携带者与护理系统的联系不安全（或支离破碎）。这项建议会 利用我们对临床和非临床数据的独特访问，衡量艾滋病毒护理结果， 干预机会，以解决与护理的不安全联系和艾滋病毒/艾滋病患者的不良结果。 我们的团队已经将来自增强的艾滋病毒/艾滋病报告系统（eHARS）的数据单独链接起来， 艾滋病毒监测数据库，以及其他公共卫生、临床和刑事司法数据。我们使用这些数据来 对印第安纳州马里恩县（印第安纳波利斯）的10，000多名艾滋病毒携带者进行人群水平的流行病学调查 从2000年到现在。我们建议将这些数据与健康数据的社会决定因素联系起来， 印第安纳州管理绩效中心（MPH），一个协作的州政府数据共享中心。英里 数据将通过添加社会经济、家庭和邻里来补充我们丰富的数据存储库 特点、社会服务利用情况（福利、食品券等），和精神健康数据。给定 国家内部和国家之间的健康和移民的社会决定因素的复杂交叉（例如， 由于住房不安全或保险覆盖面不连续），我们还将调查移民如何 与不安全的护理联系和不良结果有关。我们对这些数据源的访问将使我们能够专注于 健康和移民的社会决定因素，并将为我们提供前所未有的能力， (1)调查这些因素如何随着时间的推移与艾滋病毒的结果，（2）确定干预措施 机会（时间和地点），以改善连接到护理和临床结果在艾滋病毒携带者。 我们研究的目的是调查相关因素，以及改善艾滋病毒感染的机会， 马里恩县（印第安纳波利斯），印第安纳州的健康结果。这个假设是， 护理保留率差和病毒抑制效果差将发现改善健康结果的机会 对于那些没有安全感的艾滋病病毒携带者来说。我们的目标是（1）分析社会服务利用的模式 在PLWH中，（a）了解不良HIV结局的相关性，（B）识别非临床 干预机会;（2）确定县内和县间的移民模式 诊断后预测不良的艾滋病毒护理结果;（2a）确定人口统计学，社会经济，生命历程， 与移徙者中艾滋病毒结果更差相关的背景因素;（3）建立一个模型 扩展eHARS数据在纵向研究和公共卫生实践中的效用， 利益相关者咨询小组的建议该项目的结果将为后续的R 01应用提供信息 评估是否为那些因以下原因而被确定为风险较高的人提供补充性环绕和外展服务： 非临床服务利用和迁移模式改善了艾滋病病毒携带者的护理和结局。

SUMMARY/ABSTRACT To determine correlates of poor vs. good HIV outcomes among people living with HIV (PLWH), researchers have focused on clinical data. Hence, there is limited understanding of non‐clinical correlates and migration patterns of PLWH who have insecure (or fragmented) connections with the care system. This proposal will leverage our unique access to clinical and non‐clinical data to measure HIV care outcomes and identify intervention opportunities to address insecure connection to care and poor outcomes inPLWH. Our team has individually linked data from the Enhanced HIV/AIDS Reporting System (eHARS), the national HIV surveillance database, with other public health, clinical, and criminal justice data. We use these data to conduct population‐level epidemiology of over 10,000 PLWH in Marion County (Indianapolis), Indiana between 2000 and the present. We propose to link these data with social determinants of health data within the Indiana Management Performance Hub (MPH), a collaborative state government data‐sharing hub. MPH data will complement our rich data repository by adding socioeconomic, household, and neighborhood characteristics, social service utilization (welfare, food stamps, etc.), and mental health data for PLWH. Given the complex intersection of social determinants of health and migration within and between counties (e.g., because of housing insecurity or discontinuity of insurance coverage), we will also investigate how migration relates to insecure care connections and poor outcomes. Our access to these data sources will permit us to focus on both social determinants of health and migration, and will provide us with the unprecedented ability (1) to investigate how these factors relate to HIV outcomes over time, and (2) to identify intervention opportunities (times and places) to improve connection to care and clinical outcomes in PLWH. The objective of our research is to investigate correlates, and opportunities for improvement, of poor HIV health outcomes in Marion County (Indianapolis), Indiana. The hypothesis is that identification of correlates of poor retention in care and of poor viral suppression will identify opportunities to improve health outcomes for PLWH who are insecurely connected to care. We aim to (1) Analyze patterns in social services utilization among PLWH to (a) understand correlates of poor HIV outcomes and (b) identify non‐clinical opportunities for intervention; (2) Determine if within‐county and between‐county migration patterns after diagnosis predict poor HIV care outcomes; (2a) Identify demographic, socioeconomic, life‐course, and contextual factors associated with worse HIV outcomes among those who migrate; and (3) Develop a model to extend the utility of eHARS data for longitudinal research and public health practice, with guidance from a stakeholder advisory panel. Results from this project will inform a subsequent R01 application assessing whether supplemental wrap‐around and outreach services for those identified at higher risk due to non‐clinical service utilization and migration patterns improve care and outcomes of PLWH.