Neighborhood level determinants of delayed HIV diagnosis among Latinos by birthplace and history of injection drug use Florida 2007 2011

 描述(申请人提供)：背景：20%的艾滋病毒阳性拉美人不知道他们的艾滋病毒状况，超过一半的人被诊断得很晚。未经诊断的艾滋病毒感染者可能会继续危险的性行为和与毒品有关的行为，并在不知不觉中将他人置于危险之中。此外，延误艾滋病毒诊断已被证明增加了健康结果不佳和艾滋病毒相关死亡的风险。拉丁美洲人中艾滋病毒诊断延迟的预测因素包括年龄较大、男性、注射毒品使用(IDU)、外国出生地和低教育程度。研究表明，社区特征也可以预测医疗保健利用和健康结果，并在一定程度上解释种族/民族差异。此外，研究表明，与个体因素无关的邻里因素也可以预测注射吸毒者的艾滋病毒血清转换和高风险注射行为。目的：本研究的目的是：(A)研究不同血统的拉丁裔社区特征与延迟HIV诊断之间的关系，以及(B)确定IDU对这些关联的潜在调节作用。具体地说，这项研究将考察邻里层面的社会经济地位(失业、贫困和教育程度)和种族密度对出生国家或地区的拉美裔人艾滋病毒诊断时间的影响。设计：这项研究将使用横断面研究设计，研究2007年至2011年期间向佛罗里达州卫生部艾滋病毒/艾滋病报告系统报告的拉丁裔[13岁及以上]感染艾滋病毒的个人。美国人口普查局进行的美国社区调查将被用来确定社区特征。病例将根据艾滋病毒诊断时居住的邮政编码与邻里特征进行匹配。总样本量为[5,899]。分析：将使用混合/随机效应建模来确定邻里水平因素对延迟HIV诊断的影响。这种方法将考虑到社区内部和社区之间的非独立性(空间相关性)。邻里因素和注射毒品使用之间的相互作用项将被添加到模型中，以测试注射吸毒者作为邻里因素和延迟HIV诊断之间关系的调节因素。分析将按出生国家/地区分层，以说明不同血统的拉丁裔之间在社会经济、教育程度和医疗保健方面的巨大差异以及注射吸毒史上的差异。意义：[这一结果 这项研究将有助于确定不同血统的拉丁裔中艾滋病毒检测的可能结构性障碍和促进者。这些信息将帮助公共卫生专业人员调拨目标资源，设计更有效和更有文化能力的干预措施，以减少拉丁美洲人艾滋病毒诊断延迟的风险。]这项研究的目的与NIH/NIDA减少艾滋病毒/艾滋病的健康差距、预防艾滋病毒传播和更好地了解药物滥用和艾滋病毒/艾滋病的相互作用的战略计划是平行的。

 DESCRIPTION (provided by applicant): Background: Twenty percent of HIV-positive Latinos are not aware of their HIV status, and over half are diagnosed late. Persons with undiagnosed HIV infection can continue risky sexual and drug-related behavior and unknowingly put others at risk. Additionally, delayed HIV diagnosis has been shown to increase the risk of poor health outcomes and HIV-related mortality. Predictors of delayed HIV diagnosis among Latinos include older age, male gender, injection drug use (IDU), foreign birthplace, and low educational attainment. Studies suggest that neighborhood characteristics may also predict healthcare utilization and health outcomes and partially account for racial/ethnic disparities. Moreover, studies show that neighborhood factors, independent of individual factors, also predict HIV seroconversion and high-risk injection behavior among IDUs. Objective: The objectives of this study are to (a) examine the relationship between neighborhood characteristics and delayed HIV diagnosis among Latinos of varying origins, and (b) identify the potential moderating effects of IDU on these associations. Specifically, the study will examine the impact of neighborhood-level socioeconomic status (unemployment, poverty, and educational attainment) and ethnic density on the timing of HIV diagnosis among Latinos by country or region of birth. Design: The study will use a cross sectional study design to study Latino individuals [13 years and older] reported with HIV infection between 2007 and 2011 to the Florida Department of Health HIV/AIDS Reporting System. The American Community Survey conducted by the U.S. Census Bureau will be used to determine neighborhood characteristics. Cases will be matched to neighborhood characteristics based on the zip code of residence at the time of HIV diagnosis. The total sample size is [5,899]. Analysis: Mixed/random effects modeling will be used to determine the effect of neighborhood- level factors on delayed HIV diagnosis. This method will account for non-independence (spatial correlation) within and between neighborhoods. An interaction term between neighborhood-factors and injection drug use will be added to the model to test for IDU as a moderator of the relationship between neighborhood-factors and delayed HIV diagnosis. Analysis will be stratified by country/region of birth to account for the large socioeconomic, educational attainment, and health care access variability among Latinos of varying origins as well as the differences in history of IDU. Significance: [The results of this study will help identify possible structural barriers to and facilitators of HIV testing among Latinos of varying origins. This information will assist public health professionals to appropriatey target resources and design more effective and culturally competent interventions to decrease the risk of delayed HIV diagnosis among Latinos.] The aims of this study are parallel to NIH/NIDA's strategic plan to decrease health disparities of HIV/AIDS, prevent HIV transmission, and better understand the interaction of drug abuse and HIV/AIDS.