Ending the HIV Epidemic in Rural America (EHE-RA): Local Interventions, Co-Epidemics, and Social Determinants

结束美国农村地区的艾滋病毒流行 (EHE-RA)：当地干预措施、共同流行病和社会决定因素

• 批准号: 10619874
• 负责人: Anthony Todd Fojo
• 金额: $ 82.62万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-23 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619874
• 关键词: AIDS prevention; Address; Affect; Alabama; Behavior; Caring; Censuses; Centers for Disease Control and Prevention (U.S.); Cities; Continuity of Patient Care; Data; Disease remission; Drug usage; Economic Models; Education; Enrollment; Epidemic; Ethnic Origin; Geographic Locations; Geography; Goals; HIV; HIV Infections; Harm Reduction; Health; Health Insurance; Health Resources; Health Services Accessibility; Healthcare Systems; Home; Housing; Human immunodeficiency virus test; Incidence; Infection; Insurance; Insurance Coverage; Internet; Intervention; Link; Louisiana; Mississippi; Modeling; Opioid; Pharmaceutical Preparations; Policies; Population; Poverty; Prevalence; Prevention; Preventive; Public Health; Race; Reporting; Resources; Rural; Rural Community; Services; Subgroup; Surveys; Taxes; Testing; U.S. Department of Housing and Urban Development; United States; Viral; Virus Diseases; Vulnerable Populations; base; design; epidemiological model; ethnic minority; evidence base; health care availability; health care service; housing instability; illicit opioid; literature survey; mathematical model; opioid epidemic; opioid misuse; opioid use; opioid use disorder; pre-exposure prophylaxis; prescription opioid; programs; racial and ethnic; racial and ethnic disparities; racial minority; rural America; rural area; screening; sexual minority; social determinants; social health determinants; surveillance data; tool; transmission process; uptake; urban area

SUMMARY: Despite advances in treatment and prevention over the past decades, human immunodeficiency virus (HIV) imposes substantial burdens in the United States (US). US HIV infections are increasing concentrated in Southern states with a disproportionate number of rural infections, particularly among racial, ethnic, and sexual minorities. Rural epidemics in these states are linked to high-intensity urban epidemics, and driven by racial/ethnic disparities, poverty, inadequate insurance, limited access to healthcare, and housing insecurity. Additionally, the opioid epidemic disproportionately affects rural communities, increases HIV transmission, and hinders HIV control efforts. The Ending the HIV Epidemic (EHE) Initiative seeks to reduce HIV incidence by 90% over a decade. Ending the US HIV epidemic will require interventions tailored to local-level epidemic dynamics that address underlying drivers of transmission. Mathematical models of HIV transmission are powerful tool to forecast epidemics, and can provide evidence-based guidance on the optimal way to prioritize limited public health resources, but these models have focused primarily on urban epidemics. We have previously developed the Johns Hopkins Epidemiologic and Economic Model (JHEEM), a platform for modelling local HIV epidemics. Our objective is to generate projections of local HIV epidemics in states with a high rural burden of HIV to inform policy decisions by local health departments. We will partner health departments in three states where we have established relationships (Alabama, Louisiana, and Mississippi) to develop a suite of transmission models, based on JHEEM, that rigorously leverage local surveillance data to make projections of the HIV epidemic in each state. In Aim 1, we will develop an integrated, statewide modeling approach that links rural and urban regions using mobility data. We will use the models to identify which combinations of HIV testing, pre-exposure prophylaxis (PrEP), and viral suppression – targeted to which demographic subgroups and geographic regions – will yield the greatest reductions in incidence and disparities. In Aim 2, we will incorporate three social determinants of health: insurance, access to healthcare, and housing instability, and the racial and ethnic disparities in their distribution across the population. We will project the impact on HIV incidence and disparities of strategies that include both traditional HIV interventions and increase insurance, access to care, or stable housing. In Aim 3, we will expand JHEEM to include the opioid epidemic, and evaluate the potential reductions in HIV incidence achievable by strategies that combine harm reduction for opioid use disorder with HIV control interventions. These aims will yield a comprehensive modeling framework that links traditional HIV interventions with underlying drivers of the epidemic in rural America. Our results will provide data-driven projections, tailored to the specific needs of states, to inform effective deployment of public health resources in ending the HIV epidemic.

摘要： 尽管在过去的几十年里在治疗和预防方面取得了进展，但人类免疫缺陷病毒(HIV) 在美国(US)强加了巨大的负担。美国艾滋病毒感染日益集中在 农村感染人数不成比例的南部各州，特别是在种族、民族和性别之间 少数族裔。这些州的农村流行病与高强度的城市流行病有关，并由 种族/民族差异、贫困、保险不足、获得医疗保健的机会有限以及住房不安全。 此外，阿片类药物流行对农村社区的影响不成比例，增加了艾滋病毒的传播，以及 阻碍了艾滋病毒控制的努力。 结束艾滋病毒流行(EHE)倡议寻求在十年内将艾滋病毒发病率降低90%。结束这场 美国艾滋病毒疫情将需要针对当地流行病动态量身定做的干预措施，以解决潜在的 变速箱的驱动力。艾滋病毒传播的数学模型是预测流行病的有力工具，而且 可以提供循证指导，以最佳方式优先安排有限的公共卫生资源，但这些 模型主要关注城市流行病。我们之前已经开发了约翰·霍普金斯大学 流行病学和经济模型(JHEEM)，一个模拟当地艾滋病毒流行的平台。 我们的目标是生成艾滋病毒在农村负担较重的州的当地艾滋病毒流行预测，以提供信息 地方卫生部门的政策决定。我们将与三个州的卫生部门合作，在这些州我们有 建立了合作关系(阿拉巴马州、路易斯安那州和密西西比州)，以开发一套传输模型，基于 在JHEEM上，它严格利用当地监测数据来预测每个州的艾滋病毒流行情况。 在目标1中，我们将开发一种集成的、全州范围的建模方法，使用以下方法连接农村和城市地区 移动性数据。我们将使用这些模型来确定艾滋病毒检测、暴露前预防措施的哪些组合 (PREP)和病毒抑制--针对人口统计亚群和地理区域--将产生 最大限度地减少发病率和差距。在目标2中，我们将纳入以下三个社会决定因素 健康：保险、获得医疗保健和住房不稳定，以及 在人口中的分布。我们将预测以下战略对艾滋病毒发病率和差异的影响 既包括传统的艾滋病毒干预措施，也包括增加保险、获得护理或稳定住房。在《目标3》中， 我们将扩展JHEEM以包括阿片类药物流行，并评估艾滋病毒发病率的潜在减少 可通过将减少阿片类药物使用障碍的危害与艾滋病毒控制干预措施相结合的战略来实现。 这些目标将产生一个全面的建模框架，将传统的艾滋病毒干预措施与潜在的 美国农村地区疫情的驱动者。我们的结果将提供数据驱动的预测，为特定的 根据各国的需要，为有效部署公共卫生资源以结束艾滋病毒流行提供信息。