Examining Social Ecological and Network Factors to Assess Epidemiological Risk in a Large National Cohort of Cisgender Women

项目总结 虽然艾滋病毒预防战略有所改善，艾滋病毒在美国的发病率继续下降 在美国，仍然迫切需要加强和推进预防科学，在那些似乎出现下降的地方 已经停滞不前，特别是在有色人种的顺性女性中。来自该中心的最新监控数据 疾病控制和预防中心的数据显示，截至2019年，在所有新诊断的艾滋病毒病例中，约有7000例是 在顺性妇女(以下简称“妇女”)中被确定为女性。传统的人口统计和 行为风险因素不足以识别易受艾滋病毒感染的妇女。最新研究 关于使用风险算法来确定暴露前预防(PrEP)的资格证明很差 女性的预测能力与男性性行为中良好的预测价值形成对比。 确定易受艾滋病毒感染的妇女对于制定和部署 量身定做的预防方法。虽然女性感染艾滋病毒的方式是众所周知的，但异性恋 接触(85%)被确定为妇女中最常见的艾滋病毒传播方式，其次是15% 对于注射吸毒，人们对社会生态因素(如社区、网络、地理空间、 和政策因素)与艾滋病毒血清转换有关。总的来说，除了个人行为之外，还有几个因素 与美国女性感染艾滋病毒的风险增加有关，如性别 不平等、收入、遭受家庭暴力和性暴力、无家可归和性伴侣 特点。尽管如此，识别预测血清转换的特征组合 将妇女确定为PrEP的候选人一直是具有挑战性的。为了克服这一差距，并在 响应RFA-AI-21-058，我们建议利用创新的数字方法来建立知识库 针对生活在美国的女性，她们在行为上容易感染艾滋病毒。知识库将由一个 我们将从1800名妇女中收集艾滋病毒和性传播感染(STI)的全国队列 发病率数据和社会和性网络数据，与开源大数据配合使用，以确定艾滋病毒风险的背景 在易受艾滋病毒感染的妇女中。我们的学习团队在使用数字技术方面有丰富的经验 招募研究参与者的办法(通过电子方法和地理空间分析)。利用 我们的专业知识，我们将使用已开发的知识库来确定理论驱动的艾滋病毒相关性 血清转换、STI发生率和PrEP摄取的预测因素。这些发现将增加我们对 妇女对艾滋病毒感染的脆弱性，加强对预防接种资格的确认，并为干预措施提供信息 减少居住在美国的妇女中艾滋病毒和性传播感染的发生率。

PROJECT SUMMARY While HIV prevention strategies have improved and HIV incidence rates continue to decrease in the United States (US), a critical need remains to strengthen and advance prevention science where declines appear to have stalled, particularly among cisgender women of color. The most recent surveillance data from the Centers for Disease Control and Prevention demonstrate that as of 2019, about 7,000 of all new HIV diagnoses were identified among cisgender women (hereafter simply referred to as “women”). Traditional demographic and behavioral risk factors are insufficient to identify women who are vulnerable to HIV infection. Recent research on the use of risk algorithms to determine pre-exposure prophylaxis (PrEP) eligibility demonstrated poor predictive power for women in contrast to good predictive value among men who have sex with men. Identifying women who are vulnerable to HIV infection is crucial for the development and deployment of tailored prevention approaches. While the mode of HIV acquisition for women is well known, with heterosexual contact (85%) identified as the most frequent mode of HIV transmission among women, followed by 15% due to injection drug use, less is known about the social-ecological factors (e.g., community, network, geospatial, and policy factors) associated with HIV seroconversion. Broadly, several factors beyond individual behavior have been associated with increased risk for HIV acquisition among women in the US such as gender inequality, income, exposure to domestic and sexual violence, homelessness, and sex partner’s characteristics. Nonetheless, identifying the combination of characteristics that predict seroconversion among women and establish them as candidates for PrEP has been challenging. To overcome this gap and in response to RFA-AI-21-058, we propose to harness innovative digital methods to establish a knowledgebase for women living in the US who are behaviorally vulnerable to HIV. The knowledgebase will consist of a national cohort of 1,800 women from whom we will collect HIV and sexually transmitted infections (STIs) incidence data and social and sexual network data, paired with open-source big data to contextualize HIV risk among women vulnerable to HIV infection. Our study team has extensive experience in using digital approaches to recruit study participants (through electronic methods and geospatial analytics). Capitalizing on our expertise, we will use the developed knowledgebase to identify theoretically-driven correlates of HIV seroconversion, STI incidence, and predictors of PrEP uptake. Findings will increase our understanding of women’s vulnerabilities to HIV infection, enhance identification of PrEP eligibility, and inform interventions to decrease the incidence of HIV and STIs among women living in the US.