Neighborhoods, Networks, and the HIV Care Continuum among HIV-infected MSM in NYC

摘要 在艾滋病毒感染率、参与度和保留率方面，存在明显的种族/族裔差异 在沿艾滋病毒护理连续体的男男性行为者(MSM)中。与白人MSM相比，HIV- 被感染的黑人和西班牙裔/拉丁裔MSM不太可能接受抗逆转录病毒治疗(ART)，坚持抗逆转录病毒治疗， 并实现病毒抑制。黑人和拉丁裔男男性接触者的护理参与率和保留率较低 受个人以外的因素影响。为了发现与邻居和网络有关的 在艾滋病毒护理结果中产生种族/民族差异的途径，为 为填补黑人和拉丁裔MSM护理连续体系中的空白而采取的干预措施和政策，系统性，理论- 基于对与以下内容相关的特定和交叉邻居和网络特征的调查 必须坚持护理、坚持抗逆转录病毒治疗和抑制病毒感染。 利用社会生态学和交叉概念框架，若干中级和微观社会 和心理学理论，并得到我们NIH/NIMH R56资助的形成性研究的启发，我们建议 确定与艾滋病毒护理连续结果(病毒式)相关的社区和网络级别的特征 对居住在纽约市的550名感染HIV的男男性行为者进行的调查 (纽约市)通过一项纵向研究。我们将调查邻里组成和四个方面的影响 邻居级别的特征域，测试跨不同 MSM居住、社交和接受艾滋病毒护理的社区。 具体目标是，在纽约市感染艾滋病毒的MSM中： 目的1：使用空间分析来描述HIV护理结果的聚集性和空间趋势。 目标2：检查按种族/民族划分的艾滋病毒护理结果与纵向变化的关系：2) 接触可能产生影响的社区(住宅；社会；卫生设施通道)；2b)社区 特征概念领域(社区暴力/身体紊乱/社会混乱；AOD使用 因素；社会规范；社区资源)；2c)社会网络。 目标3：使用多水平建模来评估暴露于 社区特征和社会网络的变化与按种族/族裔划分的艾滋病毒护理结果，而 评估个人和网络层面因素的潜在中介和调节作用。 这项研究将采用一种创新的方法，将社区的地理空间制图与 多层次建模、空间统计和现有的、广泛的地理空间数据库。它将有直接的 对设计多层次干预措施的影响，解决社区、网络和 个人层面，以改善男男性接触者，特别是黑人和拉丁裔男男性接触者的艾滋病毒护理结果。

Abstract Marked disparities by race/ethnicity exist in HIV infection rates and engagement and retention in care among men who have sex with men (MSM) along the HIV care continuum. Compared with White MSM, HIV- infected Black and Hispanic/Latino MSM are less likely to be on antiretroviral therapy (ART), adhere to ART, and achieve viral suppression. Lower rates of care engagement and retention among Black and Latino MSM are influenced by factors beyond the individual. In order to uncover the neighborhood- and network-involved pathways that produce racial/ethnic disparities in HIV care outcomes, yielding an empirical basis for interventions and policies to fill gaps in the care continuum among Black and Latino MSM, systematic, theory- based investigation of the specific and intersecting neighborhood and network characteristics that relate to retention in care, ART adherence, and viral suppression must be engaged. Using socioecological and intersectional conceptual frameworks, several mid-range and micro social and psychological theories, and informed by our NIH/NIMH R56-funded formative research, we propose to identify neighborhood-and network-level characteristics associated with HIV care continuum outcomes (viral suppression, retention in care, and ART adherence) among 550 HIV-infected MSM living in New York City (NYC) via a longitudinal study. We will investigate the influence of neighborhood composition and four neighborhood-level characteristics domains, testing theoretical pathways of influence across the different neighborhoods in which MSM live, socialize, and receive HIV care. The Specific Aims are, among HIV-infected MSM in NYC: Aim 1: To use spatial analysis to characterize clustering and spatial trends in HIV care outcomes. Aim 2: To examine HIV care outcomes by race/ethnicity in relationship to longitudinal changes in: 2a) Exposure to neighborhoods of potential influence (home; social; health facility access); 2b) Neighborhood characteristics conceptual domains (community violence/physical disorder/social disorganization; AOD use factors; social norms; community resources); 2c) Social networks. Aim 3: To use multilevel modeling to assess associations among changes over time in exposure to the neighborhood characteristics and changes in social networks with HIV care outcomes by race/ethnicity, while assessing the potential mediating and moderating effects of individual- and network-level factors. The study will employ an innovative approach combining geospatial mapping of neighborhoods with multilevel modeling, spatial statistics, and an existing, extensive geospatial database. It will have direct implications for the design of multilevel interventions, addressing factors at the neighborhood-, network-, and individual-levels, to improve HIV care outcomes for MSM, particularly for Black and Latino MSM.