Understanding Health Inequities at the Intersection of the HIV and substance use epidemics across racial/ethnic and other underserved populations

在服务不足的种族/民族和边缘化人群中，艾滋病毒携带者(PWH)携带 与药物使用和艾滋病毒有关的不成比例的健康差距负担。这项研究的目标是 说明和解决城市环境保护方案在药物使用模式、药物使用治疗方面存在的差异 结果和与艾滋病毒有关的结果，包括社会、文化、结构和其他因素的贡献。 我们的重点是服务不足的种族/民族人口以及其他边缘化群体，如那些 是变性人，住房不稳定，或最近被监禁。我们会1.确定 甲基苯丙胺、可卡因和阿片类药物相关行为、危险因素和治疗结果改善 了解UREMP之间的健康差距，并更好地定制未来的干预/治疗和预防 接近了。我们将考察与毒品相关的行为的差异，包括类型、频率、使用严重程度、 给药方式、多药使用、过量用药、纳洛酮使用和药物使用治疗 结果。我们将确定人口统计、行为、心理社会和临床因素的作用，以及 纳入其他结构性/社会措施，如种族/族裔认同、污名/歧视，以及 基于社区合作伙伴、最终用户和批判性思维合作伙伴推荐的其他领域 确定药物使用模式和药物使用治疗结果差异的危险因素。2. 确定甲基苯丙胺、可卡因和阿片类药物的使用在艾滋病毒相关结局中的作用 UREMP。我们将考察吸毒、社会、文化和结构性因素之间的纵向关系， 艾滋病毒护理包括参与护理、病毒抑制和与健康相关的生活质量等一系列步骤。 我们将确定药物使用以及社会、结构和其他因素对年龄相关性合并症的影响， 如糖尿病、虚弱、心肌梗死、慢性肾脏疾病等。我们利用 在种族/民族、性别和性取向方面具有良好特征的大型威斯康星医院不同队列 艾滋病研究中心综合临床系统网络(CNICs)的综合临床数据 一群人。CNICS患者报告结果评估捕获了详细的药物使用模式、心理社会、 行为和其他因素，如社会支持和种族污名/歧视，并有助于捕获 身份的多个维度。CNIC的地理编码和仔细判定的结果有助于包括 艾滋病毒相关合并症的结构性因素和评价。CNICS数据和我们的团队带来了广度和 资源深度，通过产生与物质使用相关的新知识来回应RFA-DA-23-061 威尔斯亲王与市环保局的差距，以及社会、结构和文化因素的影响。这项研究将 为未来的研究提供信息，并在我们的社区合作伙伴关系中帮助最终用户定制未来的物质 使用治疗方案来满足与人的多维身份相关的独特需求，以便 减少受艾滋病毒护理和药物使用交汇处不平等影响的人群之间的差距。

People with HIV (PWH) in underserved racial/ethnic and marginalized populations (UREMP) carry a disproportionate burden of health disparities related to substance use and HIV. The goal of this study is to elucidate and address disparities experienced by UREMP in substance use patterns, substance use treatment outcomes and HIV-related outcomes including the contribution of social, cultural, structural, and other factors. We focus on underserved racial/ethnic populations as well as other marginalized groups such as those who are transgender, have unstable housing, or were recently incarcerated. We will 1. Determine methamphetamine, cocaine and opioid-related behaviors, risk factors, and treatment outcomes to better understand health disparities among UREMP and better tailor future intervention/treatment and prevention approaches. We will examine differences in drug-related behaviors including types, frequency, severity of use, mode of administration, polydrug use, overdoses, Naloxone access, and substance use treatment access and outcomes. We will determine the role of demographic, behavioral, psychosocial and clinical factors, and incorporate additional structural/social measures such as of racial/ethnic identity, stigma/discrimination, and other domains based on recommendations from community partners, end-users, and critical thought partners to determine risk factors for differences in drug use patterns and substance use treatment outcomes. 2. Determine the role of methamphetamine, cocaine and opioid use in HIV-related outcome disparities among UREMP. We will examine longitudinal relationships between drug use, social, cultural, and structural factors, and HIV care cascade steps such as engagement in care, viral suppression and health-related quality of life. We will determine the impact of drug use and social, structural, and other factors on age-related comorbidities, such as diabetes, frailty, myocardial infarction and chronic kidney disease among UREMP. We leverage the large well-characterized racially/ethnically, gender, and sexual orientation-diverse cohort of PWH with comprehensive clinical data in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. The CNICS patient reported outcomes assessment captures detailed drug use patterns, psychosocial, behavioral and other factors such as social support and racial stigma/discrimination and facilitates capturing multiple dimensions of identity. CNICS geocoding and carefully adjudicated outcomes facilitates including structural factors and evaluation of HIV-related comorbidities. CNICS data and our team bring a breadth and depth of resources, responding to RFA-DA-23-061 by generating new knowledge about substance use-related disparities among PWH from UREMP and the impact of social, structural, and cultural factors. This study will inform future research and assist end-users within our community partnerships in tailoring future substance use treatment programs to the unique needs associated with people’s multidimensional identities in order to reduce disparities among populations affected by inequities at the intersection of HIV care and substance use.