Examining the effects of neighborhood factors and geography on racial/ethnic disparities on achieving sustained viral suppression

检查社区因素和地理对种族/族裔差异对实现持续病毒抑制的影响

• 批准号: 10013625
• 负责人: Rahel Dawit
• 金额: $ 3.41万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-28 至 2022-04-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10013625
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Affect; Area; Caring; Case Management; Cities; Code; Continuity of Patient Care; Counseling; Country; County; Data; Data Analyses; Data Set; Development; Disease Progression; Economic Factors; Economically Deprived Population; Ensure; Epidemic; Epidemiology; Ethnic Origin; Face; Factor Analysis; Funding; Geographic Factor; Geographic Information Systems; Geography; Grant; HIV; HIV diagnosis; Haitian; Health care facility; Hispanics; Human immunodeficiency virus test; Individual; Intervention; Knowledge; Location; Logistic Regressions; Measurement; Measures; Methods; Minority; Minority Groups; Modeling; Modification; Neighborhoods; Outcome; Pattern; Pharmaceutical Preparations; Pharmacy facility; Population; Population Heterogeneity; Positioning Attribute; Postdoctoral Fellow; Poverty; Predictive Factor; Psychosocial Factor; Race; Research; Research Design; Research Personnel; Research Project Grants; Risk; Role; Site; Testing; Time; Training; Travel; Treatment outcome; Uninsured; Viral; Viral Load result; Woman; Writing; barrier to care; base; care outcomes; career; career development; contextual factors; disease transmission; ethnic minority population; experience; health disparity; health equity; improved; indexing; investigator training; metropolitan; minority investigator; neighborhood disadvantage; programs; racial and ethnic; racial and ethnic disparities; research study; responsible research conduct; retention rate; skills; social; social factors; socioeconomics; statistics; therapy design; tool; transmission process; treatment disparity

Project Summary/Abstract The risk of HIV transmission and disease progression to AIDS decreases among people living with HIV (PLHIV) that have achieved viral suppression. Prior studies have measured the last viral load in a year to assess viral suppression. However, this single measurement only provides viral suppression status at a single point in time and does not indicate sustained viral suppression throughout a year (all viral load tests within a year <200 copies/mL). Particularly, PLHIV belonging to racial/ethnic minority groups are challenged by barriers to achieving and maintaining viral suppression. Some of these barriers are related to physical and social neighborhood factors such as living in economically deprived neighborhoods. There has been little research to date about the role of neighborhood factors in achieving sustained viral suppression. Therefore, the objective of this F31 study is to assess the contribution of neighborhood, geographic and distance factors on racial/ethnic disparities in sustained viral suppression. To address this objective, secondary data analysis will be conducted using administrative data from the Miami-Dade County Ryan White HIV/AIDS Program, which provides HIV care and treatment to approximately 9,600 underserved and uninsured minority PLHIV. This proposed research study aims to (1) identify individual and neighborhood level factors that are associated with residing in geographic hotspots of low sustained viral suppression, (2) identify the moderating effect of neighborhood disadvantage on the association between race/ethnicity and sustained viral suppression, and (3) examine the moderating effect of race/ethnicity on the association between sustained viral suppression and travel time and distance to HIV case management sites and AIDS Drug Assistance Program pharmacies. The central hypothesis is that neighborhood disadvantage and distance to HIV care facility will contribute to racial/ethnic disparities in achieving sustained viral suppression. The proposed study will use multi-level mixed effects modeling to estimate the association between individual and neighborhood factors and sustained viral suppression and geographic information system tools to identify hotspots of sustained viral suppression and to determine travel time and distance to HIV care facilities. In order to successfully implement this proposed study and launch the research career of a young minority investigator, training in the following 5 areas are proposed: (1) HIV care and treatment disparities, (2) neighborhood and geographic determinants of HIV disparities, (3) multilevel mixed modeling, (4) spatial statistics, and (5) responsible conduct of research and professional development (grant and scientific writing). This study and training experience will facilitate the applicant’s development towards becoming an independent health disparities researcher and provide essential skills to help her successfully compete for a post-doctoral grant or an early career development grant funding. Furthermore, findings from this study will identify neighborhood, geographic, and distance factors that may be targeted to ensure consistent and long-term viral load suppression for vulnerable PLHIV.

项目概要/摘要 HIV 感染者的 HIV 传播和疾病进展为 AIDS 的风险降低 （PLHIV）已实现病毒抑制。此前的研究已经测量了一年内的最后一次病毒载量 评估病毒抑制。然而，这种单一测量仅提供单一的病毒抑制状态 时间点，并不表明全年持续的病毒抑制（所有病毒载量测试均在一年内进行） 年<200 拷贝/mL）。特别是属于少数种族/族裔群体的艾滋病毒感染者面临着障碍的挑战 实现并维持病毒抑制。其中一些障碍与身体和社会有关 社区因素，例如生活在经济贫困的社区。对此的研究还很少 关于邻里因素在实现持续病毒抑制中的作用的最新信息。因此，目标 这项 F31 研究的目的是评估邻里、地理和距离因素对 持续病毒抑制方面的种族/民族差异。为了实现这一目标，二次数据分析将 使用迈阿密戴德县 Ryan White HIV/AIDS 项目的行政数据进行，该项目 为约 9,600 名服务不足且未投保的少数民族艾滋病病毒感染者提供艾滋病毒护理和治疗。这 拟议的研究旨在（1）确定与以下因素相关的个人和社区层面的因素： 居住在持续病毒抑制程度较低的地理热点地区，(2) 确定以下因素的调节作用： 种族/族裔与持续病毒抑制之间关系的邻里劣势，以及 (3) 检查种族/族裔对持续病毒抑制与病毒之间关系的调节作用 前往艾滋病毒病例管理点和艾滋病药物援助计划药房的出行时间和距离。这 中心假设是，社区的劣势和距艾滋病毒护理机构的距离将导致 实现持续病毒抑制方面的种族/民族差异。拟议的研究将使用多层次混合 效应模型来估计个人和社区因素与持续病毒之间的关联 抑制和地理信息系统工具，用于识别持续病毒抑制的热点并 确定前往艾滋病毒护理机构的旅行时间和距离。为了成功实施这项拟议的研究 并启动一名年轻少数民族研究者的研究生涯，建议在以下5个领域进行培训： (1) 艾滋病毒护理和治疗差异，(2) 艾滋病毒差异的社区和地理决定因素，(3) 多级混合建模，(4) 空间统计，以及 (5) 负责任的研究和专业行为 发展（资助和科学写作）。这种学习和培训经历将有助于申请人 发展成为一名独立的健康差异研究员，并提供基本技能 帮助她成功竞争博士后资助或早期职业发展资助。 此外，这项研究的结果将确定可能影响社区、地理和距离的因素。 旨在确保对易受感染的艾滋病病毒感染者进行持续和长期的病毒载量抑制。