HIV/AIDS is one of the leading infectious diseases worldwide and has a particularly significant impact in developing countries in Sub-Saharan Africa in terms of disease and economic burden. Social determinants, including structural, community, and health systems-level factors, can have significant impact on the prevention and successful treatment of HIV, influencing individuals' behaviors around taking risks, getting tested for HIV, entering into care, being retained in care and adhering to medication long-term. However, most prior studies of social determinants of HIV outcomes have been limited in their focus on small subgroups, and/or on a small number of social determinants. To date, we still lack the fundamental understanding of the impacts of social determinants on the past, present and the future outcomes of HIV/AIDS at the country level. To address this knowledge gap, we will estimate the impact of various social determinants on the course of the HIV/AIDS epidemic using a novel analytical process that seeks to reconcile the evidence and results from natural history models and formal demographic models. The proposed model will be able to quantify the impact of different social determinants on the epidemic, to examine how different social determinants have affected the course of the epidemic and estimate their relative importance at the population level. We will leverage vast data on socio- economic covariates and behavioral risk factors from the Global Burden of Disease Study, national surveys and other sources to quantify the impact of social determinants on incidence, prevalence, and mortality of HIV/AIDS for 188 countries from 1970 to 2015. We will develop a novel analytical framework that is able to incorporate these social determinants and is based on current models that estimate the course of the HIV/AIDS epidemic to quantify the relative contribution of different social determinants. This model will be the first of its kind to enable more accurate assessment of the impact of social determinants on the ultimate measurements of the epidemic: incidence, prevalence and mortality of HIV/AIDS. Results from this analysis can help guide targeted investment and intervention to further reduce the burden of HIV/AIDS at the country level.

Public Health Relevance

The proposed project uniquely combines epidemiologic and socio-demographic methodologies to directly examine and quantify the impact of specific social determinants on national-level HIV/AIDS incidence, prevalence and mortality for 188 countries between 1970 and 2015. This novel analytic and modeling approach will enable researchers to identify key social determinants for a specific country, in order to (a) more effectively target structural interventions (such as policy changes around health systems, conditional cash transfer, or education), and (b) advance understanding of critical relationships between social determinants and behavorial risk factors and HIV outcomes, and how they change over time.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH110163-02
Application #
9243317
Study Section
Special Emphasis Panel (ZRG1-AARR-F (53)R)
Program Officer
Greenwood, Gregory
Project Start
2016-03-14
Project End
2021-01-31
Budget Start
2017-02-01
Budget End
2018-01-31
Support Year
2
Fiscal Year
2017
Total Cost
$332,424
Indirect Cost
$65,252
Name
University of Washington
Department
Public Health & Prev Medicine
Type
Schools of Public Health
DUNS #
605799469
City
Seattle
State
WA
Country
United States
Zip Code
98195
GBD 2017 Mortality Collaborators (2018) Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1684-1735
GBD 2017 Causes of Death Collaborators (2018) Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1736-1788
GBD 2017 DALYs and HALE Collaborators (2018) Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392:1859-1922
GBD 2016 Disease and Injury Incidence and Prevalence Collaborators (2017) Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1211-1259
GBD 2016 Mortality Collaborators (2017) Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1084-1150
GBD 2016 Causes of Death Collaborators (2017) Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1151-1210
GBD 2016 SDG Collaborators (2017) Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016. Lancet 390:1423-1459
GBD 2016 DALYs and HALE Collaborators (2017) Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390:1260-1344
GBD 2015 HIV Collaborators (2016) Estimates of global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2015: the Global Burden of Disease Study 2015. Lancet HIV 3:e361-e387