[R01] Understanding the association between mobility (geographic movement) and HIV outcomes among adolescents and young adults living with HIV in Tennessee
Ente: National Institute on Minority Health and Health Disparities
Scadenza: 2029-05-31
Importo max: 821.879 EUR
Paese: US
Descrizione
Modified Project Summary/Abstract Section
Adolescents and young adults living with HIV (AYA-HIV) face the highest HIV incidence and poorest care outcomes among all age groups of people living with HIV (PWH) in the United States. Geographic movement, or mobility, has emerged as a critical driver of these differences, but research in the US context is limited. The convergence of younger age and mobility poses a significant challenge to individual and public health efforts to address care challenges and end the HIV epidemic in the US. Our preliminary work in Tennessee, which includes Memphis/Shelby County, an End-the-Epidemic priority region, found that PWH change addresses nearly four times more often than the general population, with higher frequency among AYA-HIV. Mobile PWH were more likely to be lost from care, and mobility patterns followed recurring spatial pathways. Our central hypothesis is that that there are distinct mobility phenotypes among AYA-HIV and that they may differentially impact HIV care outcomes. To build on these critical findings and test this hypothesis, our experienced, multidisciplinary team will assemble a representative prospective cohort of 300 AYA-HIV in Tennessee. We will use a mixed-methods approach integrating robust individual- and population-level geospatial analyses to accomplish three Aims: 1) Determine patterns of personal mobility and multilevel (demographic and contextual) factors contributing to mobility among AYA-HIV in TN; 2) Evaluate how personal mobility impacts HIV care outcomes among AYA-HIV; 3) Assess the relationship between demographic and contextual factors on the prevalence and patterns of residential movement among all AYA-HIV in TN and the role of mobility as a mediator of the relationship between these factors and HIV care outcomes (loss to follow-up, retention and viral suppression). For Aims 1 and 2, we will a) passively monitor personal mobility of cohort members over 18 months via a global positioning system (GPS)-enabled mobile phone application, b) integrate geospatial analyses with data-informed in-depth interviews (IDIs) with AYA-HIV exhibiting potentially distinct mobility patterns (n≤30 every 6 months) to describe mobility phenotypes, and c) utilize qualitative and statistical methods to describe mobility phenotypes, elucidate factors driving personal movement and assess the relationship between mobility phenotypes and HIV care outcomes. For Aim 3, we will use population-level geospatial methods combined with HIV surveillance and census data from the TN Department of Health to explore demographic indicators and contextual factors as drivers of residential mobility, and the relationship between geographic movement and HIV care outcomes for all AYA-HIV in the state. This pioneering study will provide a rigorous, multilevel understanding of mobility among AYA-HIV in the US. By identifying mobility phenotypes and their downstream impact on health, we will lay the foundation for developin
Istituzione: MASSACHUSETTS GENERAL HOSPITAL
PI: Aimalohi Ahonkhai, Kate Clouse
Progetto: 5R01MD020283-03
Settori: National Institute on Minority Health and Health Disparities
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