The Neighborhood Context, Economics, and Health Outcomes among People with HIV

Johns Hopkins University, Baltimore MD

Investigators

Abstract

PROJECT SUMMARY The purpose of this K99/R00 Pathway to Independence Award is to support Dr. Lauren Zalla as she transitions into an independent research career focused on studying factors influencing the health of people with HIV. The K99 Phase of the award period will be completed at the Johns Hopkins Bloomberg School of Public Health. Dr. Zalla’s long-term career goal is to design and conduct rigorous epidemiologic research that addresses the health of people living with HIV. This award will allow her to gain expertise in how neighborhood conditions shape population health, and in methods for evaluating the effects of economic interventions. She will apply these skills by studying the effects of neighborhood economic conditions on care continuum outcomes among people with HIV. The study will be nested in the Johns Hopkins HIV Clinical Cohort (JHHCC), a cohort of individuals receiving HIV care at the Bartlett Clinic. The study will address the following specific aims. Aim 1: Describe the association between neighborhood economic conditions and care outcomes among participants in the JHHCC. To accomplish this aim, individual-level measures of retention in care, viral suppression, and mortality will be linked to area-level measures of neighborhood economic conditions. Aim 2: Estimate the causal effects of residential stability and residential relocation on care outcomes among participants in the JHHCC. To accomplish this aim, propensity score matching will be used to estimate the average causal effects of different residential trajectories on care outcomes. Aim 3: Quantify the impact of public and private investments in neighborhoods on care outcomes among participants in the JHHCC. This aim will use a comparative interrupted time series design and g-methods to estimate the causal effects of investments by public and private entities. This project will further our understanding of how neighborhood economic conditions affect the health of people with HIV. In doing so, it will generate evidence that directly informs the clinical care and supportive services provided to people with HIV, reduces the onward transmission of HIV, and furthers our goal of Ending the HIV Epidemic.