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Deconstructing HIV Disparities: Multistate Study of Data, Outcomes and Mediators

解构艾滋病毒差异：数据、结果和中介因素的多州研究

基本信息

批准号：
10685639
负责人：
Kathleen Ann McManus
金额：
$ 5.4万
依托单位：
UNIVERSITY OF VIRGINIA
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-08-14 至 2024-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10685639
关键词：
AIDS/HIV problem Achievement Acquired Immunodeficiency Syndrome Advisory Committees Affect Affordable Care Act African American African American population Age Factors Award Basic Science Caring Characteristics Client Clinic Clinical Research Collaborations Communicable Diseases Communities Data Data Analyses Data Collection Demographic Factors Development Plans Eligibility Determination Enrollment Epidemiology Ethnic Origin Failure Funding Future Goals HIV HIV Infections Health Health Care Costs Health Insurance Health Policy Health Sciences Healthcare Systems Individual Infection Institution Intervention K-Series Research Career Programs Lead Longevity Low income Mediator of activation protein Medicaid Mentors Mentorship Modeling Monitor Outcome Pathway interactions Persons Pharmaceutical Preparations Policies Population Population Programs Public Health Race Research Research Personnel Resource Allocation Scientist Selection Bias Service delivery model South Carolina Southeastern United States Statutes and Laws Time Training Translations Uninsured United States Universities Viral Virginia Work antiretroviral therapy base career career development cohort design disparity reduction econometrics epidemiology study experience federal policy follow-up group intervention health care delivery health disparity health plan high risk improved intravenous drug use prevent programs secondary analysis skills transmission process

项目摘要

PROJECT SUMMARY/ABSTRACT This K08 Mentored Career Development Award's overall objective is to support Dr. Kathleen A. McManus at the outset of her career, providing sufficient time to focus her research on critical issues in the intersection of epidemiology, HIV health outcomes, and health policy. Her Career Development Plan will use the context of her research for three goals: 1) master skills (design, analysis, and interpretation) of quantitative epidemiologic research; 2) gain expertise in the application of these analyses to state and federal health policy; and 3) independence. Her overarching K08 research goal is to deconstruct HIV viral suppression disparities. Specifically, she will perform secondary analyses of multistate (Virginia and South Carolina) data to 1) identify demographic and healthcare system-level factors associated with loss to follow-up of AIDS Drug Assistance Program (ADAP) clients; 2) estimate the effect of Affordable Care Act (ACA) Qualified Health Plan status on sustained individual HIV viral suppression and assess disparities in outcomes among ADAP clients; and 3) quantify the state/population level effect of modifiable healthcare delivery factors as mediators that impact disparities in viral suppression by race/ethnicity among ADAP clients. HIV viral suppression is a key outcome. It benefits individuals' longevity as well as the community since it is associated with decreases in new cases of HIV infection. This research will inform policies to reduce disparities for low-income PLWH served by ADAP. In order to monitor progress toward achieving HIV goals, states need accurate, timely data. If loss to follow-up results in data that is not missing completely at random, this could result in biased data and suboptimal policies. Understanding factors affecting loss to follow-up will help ADAPs to identify priority groups for interventions and will allow for adjustment of future analyses for selection bias. Studying this multistate ADAP cohort's ACA experience is applicable to ~225,000 ADAP clients across the nation. If the ACA is changed or repealed, or if Virginia or South Carolina expand Medicaid, the project will be adjusted to study the impact of those changes. This proposal will provide important information for state and federal policy and could become a model for HIV analyses in other states and at the federal level. It fulfills main components of the United States' National HIV/AIDS Strategy by identifying strategies to strengthen the timely availability and use of high quality data and by characterizing modifiable factors' effects on disparities that can be targeted for interventions. This proposal benefits from a strong advisory team of leading researchers with expertise in epidemiology, casual inference, econometrics, health outcomes, health policy, and HIV outcomes. Drawing from the mentorship, collaboration, and support of the Divisions of Infectious Diseases and Public Health Sciences, and state partners in Virginia and South Carolina, the University of Virginia is an ideal institution for this award with the long-term goal that Dr. McManus will become an independent clinician-researcher focused on improving health outcomes for people living with HIV by optimizing data collection and analysis, and translation of data into policy and action.

项目总结/摘要这个K 08指导职业发展奖的总体目标是支持凯瑟琳博士。麦克马纳斯在她的职业生涯的开始，提供足够的时间把她的研究重点放在交叉的关键问题，流行病学、艾滋病毒健康结果和卫生政策。她的职业发展计划将使用她的背景，研究的三个目标：1）掌握定量流行病学的技能（设计，分析和解释）研究; 2）获得将这些分析应用于州和联邦卫生政策的专业知识;以及3）独立她的总体K 08研究目标是解构艾滋病毒抑制差异。具体而言，她将对多州（弗吉尼亚州和南卡罗来纳州）数据进行二次分析，以1）确定与艾滋病药物援助失访相关的人口统计学和卫生保健系统水平因素计划（ADAP）客户; 2）估计平价医疗法案（ACA）合格健康计划状态对持续的个体HIV病毒抑制，并评估ADAP客户之间结果的差异;以及3）量化可修改的医疗保健提供因素的州/人口水平效应，作为影响 ADAP患者中不同种族/民族的病毒抑制差异。艾滋病毒的抑制是一项关键成果。它对个人和社区的长寿都有好处，因为它与减少新的艾滋病毒感染。这项研究将为政策提供信息，以减少ADAP服务的低收入艾滋病毒/艾滋病感染者的差距。在为了监测实现艾滋病毒目标的进展情况，各州需要准确、及时的数据。如果失访导致数据不是完全随机缺失的，这可能会导致有偏差的数据和次优策略。了解影响失访的因素将有助于适应行动方案确定优先干预群体，将允许调整未来的选择偏倚分析。研究这个多州ADAP队列的ACA 经验适用于全国约225，000个ADAP客户。如果ACA被更改或废除，或者弗吉尼亚州或南卡罗来纳州扩大医疗补助计划，该项目将进行调整，以研究这些变化的影响。这项提案将为州和联邦政策提供重要信息，并可能成为艾滋病毒的典范其他州和联邦一级的分析。它实现了美国国家安全体系的主要组成部分，艾滋病毒/艾滋病战略，确定加强及时提供和使用高质量数据的战略，通过描述可变因素对差异的影响，可以有针对性地进行干预。这项建议受益于一个强大的咨询团队的领先研究人员与流行病学的专业知识，因果推理，计量经济学、健康结果、卫生政策和艾滋病毒结果。从导师制，协作，以及传染病和公共卫生科学部门以及弗吉尼亚州合作伙伴的支持和南卡罗来纳州，弗吉尼亚大学是一个理想的机构，这个奖项的长期目标，博士。麦克马纳斯将成为一名独立的临床研究人员，专注于改善人们的健康状况。通过优化数据收集和分析以及将数据转化为政策和行动来应对艾滋病毒感染者。

项目成果

期刊论文数量（23）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Development of an Interdisciplinary Telehealth Model of Provider Training and Comprehensive Care for Hepatitis C and Opioid Use Disorder in a High-Burden Region.

开发针对高负担地区丙型肝炎和阿片类药物使用障碍的提供者培训和综合护理的跨学科远程医疗模型。

DOI：
10.1093/infdis/jiaa141
发表时间：
2020
期刊：
The Journal of infectious diseases
影响因子：
0
作者：
Sherbuk,JacquelineE;Knick,TerryKemp;Canan,Chelsea;Ross,Patrice;Helbert,Bailey;Cantrell,EleanorSue;Cantrell,CharleneJoie;Stallings,Rachel;Barron,Nicole;Jordan,Diana;McManus,KathleenA;Dillingham,Rebecca
通讯作者：
Dillingham,Rebecca

Geographic Variation in Qualified Health Plan Coverage and Prior Authorization Requirements for HIV Preexposure Prophylaxis.

DOI：
10.1001/jamanetworkopen.2023.42781
发表时间：
2023-11-01
期刊：
JAMA NETWORK OPEN
影响因子：
13.8
作者：
McManus, Kathleen A.;Fuller, Benjamin;Killelea, Amy;Strumpf, Andrew;Powers, Samuel D.;McQuade, Elizabeth T. Rogawski
通讯作者：
McQuade, Elizabeth T. Rogawski

Evidence From a Multistate Cohort: Enrollment in Affordable Care Act Qualified Health Plans' Association With Viral Suppression.

来自多层人群的证据：招生负担得起的护理法案合格的健康计划与病毒抑制的协会。

DOI：
10.1093/cid/ciz1123
发表时间：
2020-12-17
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
0
作者：
McManus KA;Christensen B;Nagraj VP;Furl R;Yerkes L;Swindells S;Weissman S;Rhodes A;Targonski P;Rogawski McQuade E;Dillingham R
通讯作者：
Dillingham R

Hepatitis C Within a Single Health System: Progression Along the Cascade to Cure Is Higher for Those With Substance Misuse When Linked to a Clinic With Embedded Support Services.

单一卫生系统内的丙型肝炎：当与具有嵌入式支持服务的诊所联系时，对于那些滥用药物的人来说，沿着级联治愈的进展更快。