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Principal Investigator: Lauren C. Zalla
Organization: JOHNS HOPKINS UNIVERSITY
Fiscal Year: 2024
Award: $126,387
Funding agency: National Institute of Allergy and Infectious Diseases
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.
Terms: <21+ years old><AIDS Virus><Accounting><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Address><Adult><Adult Human><Affect><Applied Skills><Area><Award><Baltimore><Black><Black race><Caring><Censuses><Cessation of life><Cities><Clinic><Clinical><Continuity of Care><Continuity of Patient Care><Continuum of Care><County><Death><Death Rate><Decrease health disparities><Environment><Epidemic><Epidemiologic Research><Epidemiologic Studies><Epidemiological Studies><Epidemiologist><Epidemiology Research><Equity><Exposure to><Foundations><Funding><Future><Gender><Goals><HIV><HIV diagnosis><Health><Health Inequity><Health disparity mitigation><Health disparity reduction><Health system><Hispanic><History><Human Immunodeficiency Viruses><Incentives><Incidence><Individual><Inequalities in Health><Inequities in Health><Institution><Interruption><Intervention><Intervention Strategies><Investments><Knowledge><LAV-HTLV-III><Link><Longitudinal Studies><Lower health disparities><Lymphadenopathy-Associated Virus><Maryland><Measures><Mentorship><Methods><Mitigate health disparities><Neighborhoods><Newly Diagnosed><Outcome><Participant><Pathway interactions><Patients><Persons><Phase><Policies><Population><Privatization><Public Health Schools><Public Policy><Qualifying><Race><Races><Recording of previous events><Reduce health disparities><Research><Research Resources><Resources><Role><Series><Services><Shapes><Social stratification><Socialization><Study Skills><Taxes><Time><Training><Transmission><United States><Viral><Virus-HIV><Work><adulthood><care outcomes><career><clinical care><cohort><comparative><deprivation><design><designing><disparity in care><disparity in health><disparity in healthcare><epidemiologic investigation><epidemiology study><health care disparity><health care inequality><health care inequity><health care outcomes><health determinants><health disparity><health equity><health inequalities><healthcare disparity><healthcare inequality><healthcare inequity><healthcare outcomes><histories><improved><indexing><interventional strategy><long-term study><longitudinal outcome studies><longterm study><mortality><mortality rate><mortality ratio><pathway><patient health information><patient health record><patient medical record><population health><programs><racial><racial background><racial origin><secondary analysis><skills><social group><social health determinants><social role><social vulnerability><structural health determinants><transmission process><urban environment><urban setting>