Social and structural violence and HIV care continuum outcomes: Developing a trauma-informed HIV care intervention among WLWH

项目概要/摘要 我们将使用创新的社会流行病学方法来纵向描述影响， 艾滋病毒护理连续体中的基于性别的暴力机制， 艾滋病毒护理模式，减轻这些关系，并建立一个平台， 艾滋病毒护理和实践（TVI-HCP）干预措施，在顺性别（顺）和变性（反）妇女生活 艾滋病毒（WLWH）。新出现的证据表明，COVID-19大流行导致了 对独联体和跨性别妇女的社会性和结构性的基于性别的暴力， 限制、物理距离和市中心经济造成的影响的份额。受到的影响 包括WLWH在内的被边缘化的顺式和跨式妇女的情况更为严重，短期和长期 顺式和反式WLWH在创伤、暴力、安全和艾滋病毒护理连续性方面的后果 需要解决的问题即使在2019冠状病毒病危机之前，尽管取得了重大的计划进展， 在许多情况下，WLWH在所有全球艾滋病毒目标方面与顺性别男子存在差距。虽然 WLWH的社会和结构性暴力在全球的流行率高得惊人，缺乏研究 描述不同类型的暴力影响艾滋病毒护理连续体成果的机制， 了解干预目标。此外，尽管有人呼吁采取创伤和暴力知情的护理方法， 艾滋病毒护理和实践（TVI-HCP）和WLWH的独特需求，令人惊讶的是，很少有人知道这是如何 这种方法可以在艾滋病毒临床实践环境中定制。在拟议的研究中，我们将利用 加拿大现有的基于社区的顺式和反式WLWH队列（性健康和艾滋病毒/艾滋病： 妇女的纵向需求评估），并重新获得和扩大这一群体，使之在 温哥华。这项定量研究将包括调查访谈、创新绘图和空间分析、艾滋病毒/艾滋病 疾病监测和保密的行政联系，以填补关键的研究空白， 多层次TVI-HCP规划的组成部分，通过以下方式优化艾滋病毒护理连续体结果：（1） 不同类型暴力经历之间关系的特征（人际关系） 情感，身体和性暴力;邻里暴力）和病毒载量抑制失败， 确定这些关系中的关键调解人进行干预;（2）profectin表征 与病毒载量有最强关联的差异化艾滋病毒护理模式的关键组成部分 抑制，扩展我们对WLWH的TVI-HCP量表的初步开发和验证;以及（3） 建立一个创新的社会流行病学平台，以告知和评估未来的多层次 了解创伤和暴力的艾滋病毒护理干预措施。在持续的COVID-19危机中，与此同时， 北美暴力，创伤和艾滋病毒的流行病，我们的研究提供了一个前所未有的机会， 提供有区别的艾滋病毒护理模式的信息，以优化边缘化妇女的艾滋病毒临床结果。

PROJECT SUMMARY/ABSTRACT We will use innovative social epidemiological methods to longitudinally characterize the impacts and mechanisms of gender-based violence on the HIV care continuum, define key components of differentiated HIV care models that mitigate these relationships and develop a platform for trauma- and violence-informed HIV care and practice (TVI-HCP) interventions, among cisgender (cis) and transgender (trans) women living with HIV (WLWH). Emerging evidence suggests that the COVID-19 pandemic has resulted in heightened social and structural gender-based violence against cis and trans women, who are shouldering an inequitable share of the resulting impact of restrictions, physical distancing and economic downtown. Impacts felt by marginalized cis and trans women, including WLWH, are even more severe and the short- and long-term consequences in terms of trauma, violence, safety and HIV care continuum outcomes of cis and trans WLWH will need to be addressed. Even prior to COVID-19 crisis, despite substantial programmatic advancements, WLWH experienced gaps relative to cisgender men in all global HIV targets in many settings. Although the global prevalence of social and structural violence by WLWH is alarmingly high, there is a lack of research delineating mechanisms through which different types of violence impact HIV care continuum outcomes, to inform intervention targets. Moreover, despite calls to apply a trauma-and violence-informed care approach to HIV care and practice (TVI-HCP) and the unique needs of WLWH, surprisingly little is known about how this approach can be tailored in HIV clinical practice environments. In the proposed study we will leverage an existing community-based cohort of cis and trans WLWH in a Canadian setting (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) and recapture and expand this cohort to 300 WLWH in the City of Vancouver. This quantitative study will include survey interviews, innovative mapping and spatial analyses, HIV disease monitoring, and confidential administrative linkages to fill critical research gaps and inform components of multi-level TVI-HCP programming to optimize HIV care continuum outcomes by: (1) Prospectively characterizing relationships between different types of violence experiences (interpersonal emotional, physical and sexual violence; neighbourhood violence) and viral load suppression failure and identifying critical mediators in these relationships on which to intervene; (2) Prospectively characterizing the key components of differentiated HIV care models that have the strongest associations with viral load suppression, expanding on our preliminary development and validation of a TVI-HCP Scale for WLWH; and (3) Establishing an innovative social epidemiological platform for informing and evaluating future multi-level trauma- and violence-informed HIV care interventions. Amidst the ongoing COVID-19 crisis, in parallel with a syndemic of violence, trauma and HIV in North America, our study offers an unprecedented opportunity to inform differentiated HIV care models to optimize HIV clinical outcomes among marginalized women.