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Multilevel Determinants and Practice-Informed Solutions to Improve HIV Transmission Risk Reporting in Arizona

Award Number: R21AI203572
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 08/05/2026
PERIOD OF PERFORMANCE END DATE: 07/31/2028

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Multilevel Determinants and Practice-Informed Solutions to Improve HIV Transmission Risk Reporting in Arizona - 7. ABSTRACT/PROJECT SUMMARY Accurate and complete HIV surveillance data are essential for guiding prevention, care, and resource allocation efforts, particularly in Ending the HIV Epidemic (EHE) priority jurisdictions. Despite national declines in new HIV infections, Arizona experienced a 20% increase in new HIV diagnoses between 2021 and 2022. In 2023, approximately 30% of new HIV diagnoses in Arizona were classified as No Risk Reported (NRR), substantially limiting the ability of state and local public health agencies to identify transmission patterns and prioritize interventions. While the Centers for Disease Control and Prevention apply multiple imputation methods to address missing transmission risk data, the validity of these estimates depends on the quality of state-submitted data and is compromised when missingness is high. HIV case reporting is a multistep process involving clinical and laboratory reporting, Disease Intervention Specialist (DIS) data collection, and county and state surveillance workflows, each introducing opportunities for missing or incomplete transmission risk information. However, little is known about the individual-, clinical-, and community-level factors associated with NRR classifications in Arizona, nor have those involved across the reporting ecosystem been systematically engaged to inform practical solutions. The overall objective of this exploratory R21 is to identify multilevel factors associated with NRR classifications in Arizona HIV surveillance data and to collaboratively develop practice-informed strategies to improve transmission risk data completeness. AIM 1 will analyze Arizona HIV surveillance data from 2020–2024 to identify individual-, clinic-, and community-level predictors of NRR using multivariable regression and systematic assessment of missing-data mechanisms. AIM 2 will convene a Practice Advisory Group including people recently diagnosed with HIV, clinicians, Disease Intervention Specialist staff, and state surveillance personnel to interpret findings, map reporting workflows, and jointly develop and prioritize feasible strategies to reduce missing transmission risk data. This project will generate actionable evidence on upstream drivers of HIV surveillance missingness and produce a practice-informed roadmap for data quality improvement. Findings will directly inform HIV surveillance and resource allocation in Arizona and lay the foundation for a subsequent R01 to develop and pilot a scalable, multi-level intervention to improve HIV transmission risk data completeness in other jurisdictions facing similar challenges.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $242,904 )
2026	2026	ARIZONA STATE UNIVERSITY	1475 N SCOTTSDALE RD STE 200	SCOTTSDALE	AZ	85257	MARICOPA	USA	Allergy and Infectious Diseases Research	000	1	8/5/2026	NEW	$242,904
														Subtotal = $242,904

Grand Total All Awards = $242,904

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Multilevel Determinants and Practice-Informed Solutions to Improve HIV Transmission Risk Reporting in Arizona

Award Number: R21AI203572

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 08/05/2026

PERIOD OF PERFORMANCE END DATE: 07/31/2028

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