People and Place: Impacts on Substance Use and HIV Outcomes in Los Angeles

University Of California Los Angeles, Los Angeles CA

Investigators

Abstract

HIV care outcomes and patterns of substance use vary significantly by geographic location. In regions like Los Angeles County (LAC), local, state, and federal policies have influenced access to healthcare and created issues, particularly for people living with HIV (PLWH) who also experience substance use (SU). Ensuring accessible, comprehensive, and patient congruent healthcare remains critical to improving both HIV and SU outcomes. Preliminary research, including our own studies, suggests that key factors influencing care utilization include the geographically dispersed locations of HIV and SU services, transportation access within large urban areas such as LAC, and limited alignment between patients and HIV care staff. While research shows that healthcare access is important, there are mixed responses of where PLWH prefer to receive care. These findings underscore the need for healthcare experiences that address geographic factors and are client responsive. Understanding how people navigate the geography of LAC to receive SU and HIV care and how peer case managers who know to navigate the geography and other factors may enhance access to care will provide novel insights into how PWLH and who use substances do or do not access treatment. We propose research and adaptation of an evidence-based intervention LINK-LA built on a previous NIDA-funded cohort, The mSTUDY (U01DA036267) and preliminary findings of an R21 on spatial connections conducted by this multi-disciplinary research team (DA049643). Applying mixed methods, we will interrogate the following (1) how public policies and practices have influence on spatial patterns and how such structural factors are associated with distinct patterns of movement across social and geographic space among PLWH in LAC and how these patterns influence where they choose to receive care. (2) How peer case managers who facilitate access to services and support to participants in the neighborhoods of their choice in LAC enhances use of services, and their HIV and SU outcomes by adapting previously proven interventions. Our proposed study will extend ongoing collaborations between the University of California, Los Angeles (UCLA), the University of California, Santa Barbara (UCSB), and a local HIV clinic resulting in a research program design that is directly informed by and responsive to patient needs. This collaborative team of scientists includes MPIs across all three career levels and local practitioners that represent an intentionally interdisciplinary and comprehensive response to improve use of and retention in HIV and SU treatment. Findings will be used to establish enhanced healthcare delivery models that improve HIV and SU outcomes.