Understanding Health Inequities at the Intersection of the HIV and substance use epidemics across racial/ethnic and other underserved populations

在服务不足的种族/族裔和边缘化群体中的艾滋病毒感染者（PWH）携带一种 与药物使用和艾滋病毒有关的健康差距造成不成比例的负担。本研究的目的是 阐明和解决UREMP在物质使用模式、物质使用治疗 艾滋病毒/艾滋病的影响包括社会、文化、结构和其他因素的贡献。 我们专注于服务不足的种族/民族人口以及其他边缘化群体，如那些 是变性人，有不稳定的住房，或最近被监禁。我们将1。确定 甲基苯丙胺，可卡因和阿片类药物相关的行为，风险因素和治疗结果，以更好地 了解农村医疗保健人员之间的健康差距，更好地制定未来的干预/治疗和预防措施 接近。我们将研究药物相关行为的差异，包括类型，频率，使用的严重程度， 给药方式、多种药物使用、过量、纳洛酮使用和物质使用治疗使用， 结果。我们将确定人口统计学、行为、心理社会和临床因素的作用， 纳入更多的结构/社会措施，如种族/族裔身份、耻辱/歧视，以及 基于社区合作伙伴、最终用户和批判性思维合作伙伴的建议的其他领域 确定吸毒模式和物质使用治疗结果差异的风险因素。2. 确定甲基苯丙胺、可卡因和阿片类药物使用在艾滋病毒相关结果差异中的作用， 我是说，我们将研究药物使用，社会，文化和结构因素之间的纵向关系， 和艾滋病毒护理级联步骤，如参与护理，病毒抑制和与健康有关的生活质量。 我们将确定药物使用和社会，结构和其他因素对年龄相关合并症的影响， 如糖尿病、虚弱、心肌梗塞和慢性肾脏病。我们利用 一个大型的种族/族裔、性别和性取向多样化的威尔斯亲王医院队列， 综合临床系统艾滋病研究网络中心（CNICS）的综合临床数据 队列。CNICS患者报告的结局评估记录了详细的药物使用模式，心理社会， 行为和其他因素，例如社会支持和种族耻辱/歧视，并促进捕获 身份的多重维度。CNICS地理编码和仔细裁定的结果有助于包括 HIV相关合并症的结构因素和评价。CNICS数据和我们的团队带来了一个广度和 资源深度，通过生成有关物质使用的新知识来响应RFA-DA-23-061 从UREMP和社会，结构和文化因素的影响PWH之间的差异。本研究将 为未来研究提供信息，并协助我们社区伙伴关系中的最终用户定制未来的实质内容 使用治疗方案来满足与人们多维身份相关的独特需求， 减少受艾滋病毒护理和药物使用交叉不平等影响的人口之间的差距。

People with HIV (PWH) in underserved racial/ethnic and marginalized populations (UREMP) carry a disproportionate burden of health disparities related to substance use and HIV. The goal of this study is to elucidate and address disparities experienced by UREMP in substance use patterns, substance use treatment outcomes and HIV-related outcomes including the contribution of social, cultural, structural, and other factors. We focus on underserved racial/ethnic populations as well as other marginalized groups such as those who are transgender, have unstable housing, or were recently incarcerated. We will 1. Determine methamphetamine, cocaine and opioid-related behaviors, risk factors, and treatment outcomes to better understand health disparities among UREMP and better tailor future intervention/treatment and prevention approaches. We will examine differences in drug-related behaviors including types, frequency, severity of use, mode of administration, polydrug use, overdoses, Naloxone access, and substance use treatment access and outcomes. We will determine the role of demographic, behavioral, psychosocial and clinical factors, and incorporate additional structural/social measures such as of racial/ethnic identity, stigma/discrimination, and other domains based on recommendations from community partners, end-users, and critical thought partners to determine risk factors for differences in drug use patterns and substance use treatment outcomes. 2. Determine the role of methamphetamine, cocaine and opioid use in HIV-related outcome disparities among UREMP. We will examine longitudinal relationships between drug use, social, cultural, and structural factors, and HIV care cascade steps such as engagement in care, viral suppression and health-related quality of life. We will determine the impact of drug use and social, structural, and other factors on age-related comorbidities, such as diabetes, frailty, myocardial infarction and chronic kidney disease among UREMP. We leverage the large well-characterized racially/ethnically, gender, and sexual orientation-diverse cohort of PWH with comprehensive clinical data in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort. The CNICS patient reported outcomes assessment captures detailed drug use patterns, psychosocial, behavioral and other factors such as social support and racial stigma/discrimination and facilitates capturing multiple dimensions of identity. CNICS geocoding and carefully adjudicated outcomes facilitates including structural factors and evaluation of HIV-related comorbidities. CNICS data and our team bring a breadth and depth of resources, responding to RFA-DA-23-061 by generating new knowledge about substance use-related disparities among PWH from UREMP and the impact of social, structural, and cultural factors. This study will inform future research and assist end-users within our community partnerships in tailoring future substance use treatment programs to the unique needs associated with people’s multidimensional identities in order to reduce disparities among populations affected by inequities at the intersection of HIV care and substance use.