Viral Suppression for People with HIV with Low Incomes: Study of Disparities, Health Equity, and Best Practices

低收入艾滋病毒感染者的病毒抑制：差异、健康公平和最佳实践的研究

• 批准号: 10619064
• 负责人: Kathleen Ann McManus
• 金额: $ 73.68万
• 依托单位: UNIVERSITY OF VIRGINIA
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-24 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10619064
• 关键词: Acquired Immunodeficiency Syndrome; Adopted; Advocate; Age; Arizona; Binding; Black AIDS; Black race; Budgets; Caring; Client; Communities; Data; Decision Making; Development; Disparity; District of Columbia; Eligibility Determination; Epidemic; Epidemiologic Methods; Epidemiology; Ethnic Origin; Florida; Funding; Geography; Goals; HIV; HIV Infections; Hawaii; Health; Health Care Costs; Health Services Accessibility; Healthcare; Incidence; Income; Individual; Interruption; Intervention; Interview; Laws; Leadership; Left; Low income; Mediating; Morbidity - disease rate; North Carolina; Outcome; Persons; Pharmaceutical Preparations; Policies; Policy Maker; Population; Principal Investigator; Public Health; Qualifying; Qualitative Methods; Race; Regulation; Research; Research Personnel; Resource Allocation; Resources; South Carolina; Structure; Subgroup; Surveys; Tennessee; Territoriality; Translating; Translations; Underinsured; Uninsured; United States; Variant; Viral; Viral Load result; Virginia; Work; antiretroviral therapy; cohort; comorbidity; disparity reduction; experience; falls; federal poverty level; flexibility; geographic disparity; health care delivery; health equity; improved; insurance plan; mortality; novel; prevent; programs; safety net; simulation; transmission process

PROJECT SUMMARY/ABSTRACT People with HIV (PWH) need consistent access to care and antiretroviral therapy (ART) to achieve the sustained viral suppression (VS) critical for individual health (reduced morbidity, comorbidities, and mortality) and public health (preventing transmission of HIV). The United States (US) has significant geographic disparities in HIV VS for PWH with low incomes who rely on state AIDS Drug Assistance Programs (ADAPs), ranging 53% to 99%. ADAPs support 26% of PWH in the US with a $2.4 billion annual budget. As a key part of the US HIV healthcare delivery safety net, ADAPs provide free ART by direct provision or through ADAP-subsidized insurance plans. ADAP implementation varies widely because individual state ADAPs have decision-making flexibilities for health- care delivery programs and policies. Additionally, how ADAPs perform for different subgroups remains unknown. Understanding how ADAPs can optimize VS could reduce healthcare costs, because each HIV infection averted saves $402,000. To support ending the US HIV epidemic, our long-term goal is to use epidemiologic, including causal inference framework, and qualitative methods, to identify how to improve VS for all PWH, including those with low incomes, through healthcare delivery programs. With a focus on disparities and health equity, our over- arching research question is what specific healthcare delivery programs and policies for PWH with low incomes increase sustained VS rates and reduce VS disparities related to race/ethnicity? Our team has studied ADAPs since 2014. Our study results have been used to advocate to successfully change healthcare laws. The Principal Investigator, the only researcher with federal funding to study this aspect of HIV healthcare delivery, and the interdisciplinary team will use expertise in novel causal epidemiology and qualitative methods. We have partner- ships with the National Alliance of State & Territorial AIDS Directors (NASTAD) and six state health departments providing access to multistate individual-level data (comprising 20% of ADAP clients; including ADAPs at VS rate extremes), and for a national study, we will interview AIDS/ADAP leadership. We will complete the following: Aim 1: we will decompose disparities in sustained VS related to race/ethnicity. We will quantify the mediating effect of a modifiable factor, ADAP healthcare delivery programs. Aim 2: we will quantify potential improvements in sustained VS for individual state ADAPs informed by state ADAP client mix. Using simulation for all state ADAPs, we will estimate the impact on sustained VS of ADAP clients changing to specific ADAP programs. Aim 3: we will perform interviews of AIDS/ADAP Directors across the nation. Using qualitative analyses, we will iden- tify the ADAP programs and policies that improve VS and improve health equity. Successful completion of this work will provide evidence to inform state/federal regulation and resource prioritization toward the goal of helping people achieve VS and interrupting HIV transmission. Our findings would allow state ADAPs, advocates, policy- makers, and Ending the HIV Epidemic initiative leaders to adopt best practices identified from our study and to develop new interventions (laws, guidance, funding) to optimize VS- translating data into policy and action.

项目摘要/摘要 患有艾滋病毒（PWH）的人需要持续获得护理和抗逆转录病毒疗法（ART）才能实现持续的 病毒抑制（VS）对个人健康至关重要（降低发病率，合并症和死亡率）和公众 健康（防止HIV传播）。美国（美国）在艾滋病毒与 对于依靠国家艾滋病药物援助计划（ADAPS）的PWH，范围为53％至99％。 ADAPS年度预算为24亿美元，在美国支持26％的PWH。作为美国艾滋病毒医疗保健的关键部分 递送安全网，ADAPS通过直接提供或通过ADAP提出的保险计划提供免费艺术。 ADAP的实施差异很大，因为单个状态ADAP具有针对健康的决策灵活性 - 护理提供计划和政策。此外，对不同亚组的辅助性能如何保持未知。 了解ADAP可以如何优化VS可以降低医疗保健成本，因为每种艾滋病毒感染都避免了 节省$ 402,000。为了支持结束美国艾滋病毒流行，我们的长期目标是使用流行病学，包括 因果推理框架和定性方法，以确定如何改善所有PWH，包括 收入低，通过医疗保健提供计划。侧重于差异和健康公平，我们的过度 拱门研究问题是较低收入的PWH的特定医疗保健提供计划和政策 提高持续的VS率并减少与种族/种族有关的差异？我们的团队研究了适应性 自2014年以来。我们的研究结果已被用来倡导成功改变医疗保健法。校长 研究人员，唯一拥有联邦资助的研究人员，研究了艾滋病毒医疗保健提供的这一方面， 跨学科团队将使用新的因果流行病学和定性方法中的专业知识。我们有合作伙伴 - 与国家和领土艾滋病董事联盟（NASTAD）和六个州卫生部门的船舶 提供对多级个体级别数据的访问（包括20％的ADAP客户端；包括vs的ADAPS 极端速率），对于国家研究，我们将采访艾滋病/适应性领导。我们将完成以下内容： 目标1：我们将分解与种族/种族有关的持续VS的差异。我们将量化调解 可修改因素，ADAP医疗保健提供计划的效果。目标2：我们将量化潜在的改进 在国家ADAP客户组合所通知的单个状态ADAP中的持续VS中。对所有状态使用模拟 ADAPS，我们将估计对ADAP客户的持续VS的影响，更改为特定的ADAP程序。目的 3：我们将对全国各地的艾滋病/ADAP总监进行采访。使用定性分析，我们将识别 介绍改善VS和改善健康公平的ADAP计划和政策。成功完成 工作将提供证据，以告知州/联邦法规和资源优先级，以帮助 人们实现与中断艾滋病毒的传播。我们的发现将允许国家适当，倡导者，政策 - 制造商，结束艾滋病毒流行倡议领导人，以采用从我们的研究中确定的最佳实践和 制定新的干预措施（法律，指导，资金），以优化将数据转化为政策和行动。