Patterns and predictors of racial/ethnic disparities in HIV care continuum in the South

项目摘要/摘要 HIV护理连续体(HCC)，一个描述当前临床目标的令人信服的框架 HIV感染，跟踪艾滋病毒携带者(PLWH)从诊断到联系到 护理，留住护理，并最终达到抑制病毒的目标。不幸的是，健康差距存在于 在种族/少数民族人口中的每一步。这种种族/民族差异可能会 显著延缓了美国南部各州肝癌的进展，这些州在以下方面具有很强的代表性 2019年联邦倡议中的地理重点领域，题为“结束艾滋病毒流行：美国的计划” (Ethe)。鉴于南方一些地区随着时间的推移，种族隔离程度有增无减，至关重要的是 确定肝癌预后中健康差异的驱动因素，促进健康公平和改善人口状况 健康。只注重个人层面的战略，以改善健康和改善健康差距 据报道无效。认识到社会因素的影响，这些因素被称为基本因素 种族/民族健康差异的原因，因为它们在塑造其他无数重要因素方面发挥了作用 促进健康公平，促使全球将重点从简单地解决症状和 在评估和治疗时，也要考虑患者的社会需求和生活经历。 然而，在量化肝细胞癌的长期时空变异方面所做的努力有限 随时间推移的差距及其促成因素，特别是在新冠肺炎大流行的背景下。使用 NIH支持(R01AI127203)自2017年以来，我们一直在利用大数据方法来检查治疗差距 在南卡罗来纳州(SC)的PLWH中。正在进行的研究从以下方面提取并关联纵向EHR数据 六个州政府机构。现有项目中的队列包括所有在12月前诊断为PLWH的人 2020年加州为了解决与肝癌相关的健康差距研究中的差距，我们将利用现有的数据 从R01AI127203项目并将这些数据链接到聚集的社区和社会结构层数据(例如， 结构性种族主义、新冠肺炎大流行)来自多个公开可用的数据来源。超出...的范围 在最初的项目中，我们将首先确定种族差异的时空模式(例如，加剧或 衰减趋势)，然后确定上下文特征对时间的贡献 应用带套索惩罚的多变量广义回归分析肝细胞癌患者的差异。建议数 研究具有创新性和重要意义，因为识别和减少肝癌患者的种族/民族差异 结果对于了解不良的肝细胞癌预后的根本原因和不断演变的风险至关重要 在南卡罗来纳州和美国南部其他州实现ethe目标。研究结果可能会让州政府 卫生署促进社会平等，推动医疗系统满足病人的社会需求 作为医疗保健提供的一部分，并为社会弱势群体制定更精确、更有针对性的干预战略 实现健康平等和改善艾滋病毒治疗结果的领域。

Project Summary/Abstract The HIV care continuum (HCC), a compelling framework to describe the current clinical goals for managing HIV infection, tracks the progression of people living with HIV (PLWH) from diagnosis, through linkage to care, retention in care, and ultimately to the goal of viral suppression. Unfortunately, health disparities exist at every step of the continuum among racial/ethnic minority population. Such racial/ethnic disparities may have significantly delayed the progress in HCC in the Southern US states that are strongly represented among geographic focus areas in the 2019 federal initiative titled “Ending the HIV Epidemic: A Plan for America” (EtHE). Given the unabated high levels of segregation over time in some areas of the South, it is critical to identifying drivers of health disparities in HCC outcomes and advance health equity and improve population health. A singular focus on individual-level strategies to improve health and ameliorate health disparities has been reported ineffective. Recognition of the impact of social factors, which have been coined as fundamental causes of racial/ethnic health disparities because of their role in shaping other myriad factors important for promoting health equities, has prompted a global shift in focus away from simply addressing symptoms and conditions to also considering patient social needs and lived experiences in assessment and treatment. However, limited efforts have been made to quantify the long-term spatiotemporal variations of HCC disparities and their contributing factors over time, particularly in the context of COVID-19 pandemic. With NIH support (R01AI127203) since 2017, we have been utilizing a Big Data approach to examine treatment gaps among PLWH in South Carolina (SC). The ongoing research extracted and linked longitudinal EHR data from six state agencies. The cohort in the existing project include all PLWH who were diagnosed through December 2020 in SC. To address the gaps in HCC-related health disparity research, we will leverage the exiting data from R01AI127203 project and link these data to aggregated community and social structural level data (e.g., structural racism, COVID-19 pandemic) from multiple publicly available data sources. Beyond the scope of original project, we will first identify the spatiotemporal patterns of racial disparities (e.g., exacerbating or attenuating trend) of each HCC outcome, then determine the contribution of contextual features for temporal change of disparities in HCC using the multivariable generalized regression with lasso penalty. The proposed research is innovative and significant because identifying and reducing racial/ethnic disparities in HCC outcomes is essential to understand the fundamental causes and evolving risk of poor HCC outcomes and achieve the EtHE goals in SC and other Southern states in the US. The research findings could inform state health department to promote social equality, motivate healthcare systems to address patients’ social needs as part of healthcare delivery, and devise more precise, targeted intervention strategies for socially disadvantaged areas to achieve the health equality and improve HIV treatment outcomes.