Place characteristics & disparities in HIV in IDUs: A multilevel analysis of NHBS

描述(由申请人提供)：美国注射器中艾滋病毒感染率的种族/民族差异一直很大且持续存在；在使用卫生服务预防和治疗艾滋病毒方面也存在差异。需要新的方法来解释和消除这些差异，国家开发协会、疾病预防控制中心、国家艾滋病毒/艾滋病战略和2020年健康人呼吁研究和干预人们居住的地方的特点如何在艾滋病毒和与艾滋病毒相关的卫生服务使用方面造成并延续差异。这项拟议的研究将对地方特征与艾滋病毒相关健康和注射器健康服务使用方面的种族/民族差异的关系进行美国有史以来最全面的分析。由于美国疾病控制与预防中心允许我们访问2009年和2012年国家艾滋病毒行为监测(NHBS)关于注射器的数据库，我们将能够描述一系列与艾滋病毒相关的健康和卫生服务结果中注射器种族/民族差异的地理和时间差异，其中一些以前从未研究过。通过将2009年和2012年的NHBS数据与现有的行政数据库相结合，我们将能够开创性地分析以前未被研究但潜在的强大的地方特征如何与差异有关。许多地方特征是可以修改的，我们将专注于确定与缩小差距相关的可修改特征。我们将实现以下目标：目标1：记录2012年注射器中艾滋病毒相关健康和健康服务成果方面种族/族裔差异的地理差异，并描述这些差异随时间的变化(2009-2012年)。目标2：描述2012年不同种族/族裔的注射器在卫生服务环境、与毒品有关的刑事司法环境和社会经济环境中暴露的变化，并描述2009-2012年期间这些暴露的变化。目标3：分析2012年的数据，以描述卫生服务、与毒品有关的刑事司法和社会经济环境与注射者艾滋病毒相关卫生和卫生服务结果差异的关系。应用人群归因危险度和Blinder-Oaxaca方法详细检查具体环境特征与差异的关系。目标4：分析注射器卫生服务、与毒品有关的刑事司法和社会经济环境的变化如何与差距随时间的变化有关(2009-2012年)。目标5：利用目标1-4中产生的结果，开发基于试剂的模型(ABM)，以了解特定环境特征变化对注射者艾滋病毒相关健康和健康服务结果差异的可能影响。创新旨在加强研究对政策和干预措施的影响，包括应用Blinder-Oaxaca方法、人口归因风险分析和ABM。一个强大的团队将实现这项研究的目标，包括汉娜·库珀博士、唐·德斯·贾莱斯博士和塞缪尔·弗里德曼博士。我们的专业知识涵盖关键方法(例如，地理空间和多层次方法)、实质(例如，艾滋病毒的社会决定因素)和传播战略，以促进影响。

DESCRIPTION (provided by applicant): Racial/ethnic disparities in HIV prevalence among injectors in the US have been substantial and persistent; disparities also exist in the use of health services to prevent and treat HIV. New approaches are needed to explain and eliminate these disparities, and NIDA, the CDC, the National HIV/AIDS Strategy, and Healthy People 2020 have called for research and interventions into the ways in which characteristics of the places where people live create and perpetuate disparities in HIV and in HIV-related health service use. The proposed study will undertake the most comprehensive analysis ever conducted in the US of the relationships of place characteristics to racial/ethnic disparities in HIV-related health and health service use among injectors. Because the CDC has granted us access to its 2009 and 2012 National HIV Behavioral Surveillance (NHBS) databases on injectors, we will be able to describe geographic and temporal variations in racial/ethnic disparities among injectors in a range of HIV-related health and health service outcomes, some of which have never been studied before. By integrating 2009 and 2012 NHBS data with existing administrative databases, we will be able to pioneer analyses of how previously-unstudied but potentially powerful place characteristics relate to disparities. Many place characteristics can be modified, and we will focus on identifying modifiable characteristics that are associated with reducing disparities. We will achieve the following aims: Aim 1: Document geographic variations in racial/ethnic disparities in HIV-related health and health service outcomes among injectors in 2012, and describe changes in these disparities over time (2009-2012). Aim 2: Describe variations in exposure to features of the health service environment, drug-related criminal justice environment, and socioeconomic environment across racial/ethnic groups of injectors in 2012, and describe changes in these exposures between 2009-2012. Aim 3: Analyze 2012 data to describe relationships of the health service, drug-related criminal justice, and socioeconomic environments to disparities in HIV-related health and health service outcomes among injectors. Apply population attributable risk and Blinder-Oaxaca methods to examine the associations of specific environmental features to disparities in detail. Aim 4: Analyze how changes in injectors' health service, drug-related criminal justice, and socioeconomic environments are related to changes in disparities over time (2009-2012). Aim 5: Draw on findings generated in Aims 1-4 to develop agent-based models (ABMs) of the possible effects of changing specific environmental features on disparities in HIV-related health and health service outcomes among injectors. Innovations are designed to enhance the study's impact on policies and interventions and include applying Blinder-Oaxaca methods, population attributable risk analyses, and ABMs. A strong team will achieve this study's aims, including Drs. Hannah Cooper, Don Des Jarlais, and Samuel Friedman. Our expertise spans key methods (e.g., geospatial and multilevel methods, ABMs), substance (e.g., social determinants of HIV), and dissemination strategies to promote impact.