Using geospatial science to maximize the opportunity to access ART in Africa

项目概要/摘要 该提案旨在制定和实施量化撒哈拉以南非洲地区地域差异的方法， 非洲国家，艾滋病毒感染者有机会获得抗逆转录病毒疗法; 并确定减少这种差距的最佳战略。我们将开发的方法构成了一个 一个新颖的分析框架，我们将使用它来完成我们的三个具体目标：（1）首先，我们将开发一个 空间相互作用模型，可应用于任何撒哈拉以南非洲国家，以估计 获得抗逆转录病毒治疗，并确定在这一机会的差距。我们将把这一模式应用于马拉维， 世界上最严重的艾滋病毒流行病，我们以前的研究表明， 在获得艾滋病毒护理方面存在巨大的地域差异。为此，我们将分析一系列数据集，包括 全国马拉维基于人口的艾滋病毒影响评估[MPHIA]; MPHIA收集于 2015/16和2020/21，跨越了ART覆盖率大幅增加的时期。(2)二是 量化获得抗逆转录病毒治疗的机会与其实际利用率之间的地理关系， 确定两个时间点之间这种关系的变化程度。(3)第三，我们将利用我们的 在进一步分析MPHIA 2020/21数据集的建模框架，目的是确定最佳的 减少获得抗逆转录病毒治疗机会方面的地域差距的战略; 我们将通过增加抗逆转录病毒药物的供应， 通过美国的研究-马拉维协作小组。

PROJECT SUMMARY / ABSTRACT This proposal is to develop and implement methods for quantifying geographic disparities, within Sub-Saharan African countries, in the opportunity for people living with HIV (PLHIV) to access antiretroviral therapy (ART); and to identify optimal strategies for reducing such disparities. The methods that we will develop constitute a novel analytic framework, which we will use to complete our three Specific Aims: (1) First, we will develop a spatial interaction model which can be applied in any SSA country to estimate the geographic opportunity to access ART and to identify disparities in this opportunity. We will apply the model to Malawi, which has one of the most severe HIV epidemics in the world, and where our previous studies have shown that PLHIV face substantial geographic disparities in accessing HIV care. To do so we will analyze a series of datasets, including the nationwide Malawi Population-based HIV Impact Assessments [MPHIAs]; the MPHIAs were collected in 2015/16 and 2020/21, spanning a period when ART coverage increased substantially. (2) Second, we will quantify the geographic relationship between the opportunity to access ART and its actual utilization, and determine the degree to which this relationship changed between the two timepoints. (3) Third, we will use our modeling framework in further analyses of the MPHIA 2020/21 dataset with the objective of identifying optimal strategies to reduce geographic disparities in the opportunity to access ART; both through the location of new healthcare facilities (HCFs) and through the allocation of additional supplies of ART. We will conduct these studies through a U.S.-Malawi collaborative team.