The DC Cohort: A Longitudinal Population-Based Cohort Study of People Living with HIV in Washington, DC

项目摘要 华盛顿特区约有13,000名艾滋病毒携带者(PLWH)，是美国 美国总共贡献了新艾滋病毒诊断的50%。在我们努力结束艾滋病毒流行的同时， 能够确定新诊断的艾滋病毒感染者的特征，有效地指导艾滋病毒的治疗工作 和它的共生情况，并使用新的预防工具来避免进一步的传播，是至关重要的 重要性。DC队列，一项对15个临床站点接受护理的10,000多名PLWH进行的纵向队列研究 在华盛顿，它在帮助结束艾滋病毒流行方面处于独特的地位。该队列成立于2011年，目标是 通过改善护理质量，扭转哥伦比亚特区艾滋病毒流行的轨迹。这群人参与了 学术和社区诊所，链接到DC Health Department(DOH)数据库，并提供近 使用数据可视化临床仪表板向诊所提供关于艾滋病毒结果的实时性能反馈。所有的 这是通过自动数据提取和协调电子病历数据来实现的 不同的临床环境和所有年龄段。该队列提供了具有代表性的、人口层面的和 具有科学生产力的研究资源，这在大多数城市高发城市中是不存在的。盖楼 Cohort的基础设施和成就，我们将扩展这个强大的人口级数据存储库，以 全面和纵向跟踪高发城市中PLWH的结果。我们将把 队列中的新数据来源包括行政、服务、药房、其他共病和 患者报告的结果数据。获取多层次数据将加强对艾滋病毒的监测，并共同 病态后果。接下来，我们建议使用队列来监控结束的影响和效果 在哥伦比亚特区开展艾滋病毒流行(EHE)活动，并为各国的EHE努力提供经验教训。这个 Dashboard将监测关键的EHE指标：保留在护理中；病毒抑制(VS)；可用性、启动和 新的抗逆转录病毒疗法的有效性；以及缩小健康差距。有了这个工具，当地的艾滋病毒提供者和 DC DOH可以支持那些结果不佳的风险最大的人。最后，我们将使用队列来 制定开创性的干预措施，以提高PLWH的护理质量。我们会与区议会合作 艾滋病研究中心、地方和国家艾滋病毒调查人员以及社区利益攸关方，以确定和 制定临床、流行病学、社会行为、基础科学和实施科学干预措施，以 改善护理。我们将使用队列基础设施来确定这些项目的潜在参与者和临床地点 支持美国国立卫生研究院资助的研究和其他研究建议。队列的目标与Oar，NIAID， 和EHE优先事项，重点是减少健康差距，实现VS，监测护理质量，以及 改进艾滋病毒相关临床结局的管理。DC队列是无与伦比的临床， 研究和公共卫生资源，使我们能够监测一个高流行城市的护理。教训 学习将产生可推广的知识，可以应用于美国其他城市热点地区。

Project Abstract Washington, DC has approximately 13,000 people living with HIV (PLWH) and is one of the HIV “hotspots” in the US that collectively contribute to 50% of new HIV diagnoses. As we strive to end the HIV epidemic, the ability to characterize persons who are newly diagnosed with HIV, effectively direct treatment efforts for HIV and its co-occurring conditions, and use novel prevention tools to avert further transmissions, are of critical importance. The DC Cohort, a longitudinal cohort study of over 10,000 PLWH receiving care at 15 clinical sites in DC, is uniquely positioned to help end the HIV epidemic. The Cohort was launched in 2011 with the goal of bending the trajectory of the HIV epidemic in DC by improving the quality of care. The Cohort engages academic and community-based clinics, links to DC Health Department (DOH) databases, and provides near real-time performance feedback to clinics on HIV outcomes using a data visualization Clinical Dashboard. All of this is achieved through automated data extraction and harmonization of electronic medical records data from varied clinical settings and all age groups. The Cohort provides a representative, population-level and scientifically productive research resource that does not exist in most urban high prevalence cities. Building off the Cohort’s infrastructure and achievements, we will expand this robust population-level data repository to comprehensively and longitudinally track outcomes among PLWH in a high prevalence city. We will incorporate new data sources into the Cohort including administrative, service, pharmacy, additional co-morbidity and patient-reported outcomes data. Access to multi-level data will enhance the monitoring of HIV and co- morbidities outcomes. Next, we propose to use the Cohort to monitor the impact and effectiveness of Ending the HIV Epidemic (EHE) initiatives in DC and contribute lessons learned to national EHE efforts. The Dashboard will monitor key EHE indicators: retention in care; viral suppression (VS); availability, initiation and efficacy of new ARV therapeutics; and reductions in health disparities. With this tool, local HIV providers and the DC DOH can support those at greatest risk for suboptimal outcomes. Finally, we will use the Cohort to develop pioneering interventions to improve the quality of care among PLWH. We will partner with the DC Center for AIDS Research, local and national HIV investigators, and community stakeholders to identify and develop clinical, epidemiologic, socio-behavioral, basic science, and implementation science interventions to improve care. We will use the Cohort infrastructure to identify potential participants and clinical sites for these studies in support of NIH-funded and other research proposals. The goals of the Cohort align with OAR, NIAID, and EHE priorities which focus on reducing health disparities, achieving VS, monitoring quality of care, and improving the management of HIV-related clinical outcomes. The DC Cohort is an unparalleled clinical, research, and public health resource which enables us to monitor care in a high prevalence city. Lessons learned will produce generalizable knowledge that can be applied in other urban hotspots across the US.