The Urban Environment as a Modifiable Social Determinant of Health among People with HIV

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 the modifiable place-based determinants of health among 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 structural determinants of health and health equity among people living with HIV. This award will allow her to gain expertise in the role of the urban environment in shaping population health, and in methods for evaluating

the effects of neighborhood-level exposures and policy interventions on health and health equity. She will apply these skills by studying the effects of neighborhood deprivation, residential relocation, and neighborhood change on care continuum outcomes among people with HIV. The study will be based in Baltimore, Maryland,

a large and diverse “city of neighborhoods” with a history of disinvestment and a disproportionate burden of 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 in East Baltimore. The study will address the following specific aims.

Aim 1: Describe the association between neighborhood deprivation 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 deprivation at the census block group level. Aim

2: Estimate the causal effects of residential stability and relocation to lower- or higher-deprivation neighborhoods 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 neighborhood investments, and will specifically consider the effects

of direct investments by a place-based nonprofit investment fund capitalized by the City and tax incentives to private developers through the designation of federally-qualified Opportunity Zones. This project will further our understanding of neighborhood effects on health among people with HIV. In doing

so, it will generate evidence that directly informs the clinical care and supportive services provided to people with HIV and that shapes public policy aimed at reducing the onward transmission of HIV, improving health equity among people with HIV, and ultimately Ending the HIV Epidemic.