Advancing knowledge on factors that promote or impede engagement along the HIV care continuum over time: A longitudinal mixed methods study of Black and Latinx youth/emerging adults living with HIV

项目摘要：青少年艾滋病毒携带者(LWH)从青春期到成长期 新兴成年期(16-28岁)，我们称之为“青年和新兴成年人”(YA)，他们有 在所有年龄段中，艾滋病毒护理连续体(HCC)的参与率最低。这场糟糕的订婚是 最明显的是非洲裔美国人/黑人和拉丁裔YEA-LWH，包括性/性别少数，那些 使用酒精/毒品的人，以及社会经济地位低的人。然而，我们所知道的 促进或阻碍肝细胞癌沿线参与的因素，以及它们如何随着时间的推移运作和相互作用，是 对于有限的发生行为(例如，艾滋病毒护理预约)和重复发生的行为都是不够的 行为(例如，坚持艺术)。这些差距限制了政策和卫生服务的创新。建议数 前瞻性纵向研究使用混合方法，重点是非洲裔美国人/黑人和拉丁裔美国人- LWH既有病毒抑制也有无病毒抑制。这项研究使用了定量、定性、生物标记物(艾滋病毒 负载、药物使用)和生态瞬时评估方法，以发现、描述和更好地 准确了解影响肝细胞癌随时间推移的接触轨迹的因素， 包括从YEA-LWH的角度来看。这项研究以社会行动理论为基础，这是一项全面的 社会-认知/生态模型，允许检查上下文影响(例如，行动)的变化 背景，如种族主义和仇视同性恋；自律资源，如药物使用)，自我改变 流程(例如，包括社交网络的社交互动流程；激励评估)和行动 (例如，参加艾滋病毒护理预约、[根据需要]进行药物使用治疗、重新启动抗逆转录病毒治疗)。 这项研究的主要结果是HIV病毒抑制(VS)。提出了两个相互关联的目标： 描述在社会行动理论的指导下，沿着癌症中心的参与轨迹(目标1)，以确定， 描述并了解阻碍或影响环境的影响、自我改变过程和行动状态 支持包括随着时间推移而参与的行为，包括YEA-LWH 对这些因素的看法(目标2)。青年顾问委员会将由科学顾问加入，以制定 根据研究结果提出可行的建议，并将予以传播。参与者(N=270，一半 注册时有艾滋病毒感染者和一半非抑制者)将是多样化的非裔美国人/黑人或拉丁裔 在纽约市和新泽西州纽瓦克招募的行为感染YA-LWH使用经过验证的混合策略。我们 将使用混合方法前瞻性地跟踪参与者18个月，将基线和随访相结合 数据(N≈810病毒载量观察)，以评估预期促进或阻碍的多方面结构域 沿着肝细胞癌的参与，以及Ya-LWH对其原因和意义的看法。研究团队 是纵向混合方法研究、肝癌研究和AABL YEA方面的专家。这项拟议的研究与 与NIH的优先事项，并将推动解决这一严重的公共卫生问题。

PROJECT SUMMARY: Young people living with HIV (LWH) in the developmental periods from adolescence to emerging adulthood (ages 16-28 years), which we refer to as “youth and emerging adults” (YEA), have the lowest rates of engagement along the HIV care continuum (HCC) of any age group. This poor engagement is most pronounced for African American/Black and Latinx YEA-LWH, including sexual/gender minorities, those who use alcohol/drugs, and individuals from low socioeconomic status backgrounds. Yet, our knowledge of factors that promote or impede engagement along the HCC, and how they operate and interplay over time, is insufficient, for both limited occurrence behaviors (e.g., HIV care appointments) and repeated occurrence behaviors (e.g., ART adherence). These gaps limit innovations to policy and health services. The proposed prospective longitudinal study uses mixed methods and focuses on African American/Black and Latinx YEA- LWH both with and without viral suppression. The study uses quantitative, qualitative, biomarker (HIV viral load, drug use), and ecological momentary assessment approaches to uncover, describe, and better understand factors contributing to trajectories of engagement along the HCC over time, with precision, including from YEA-LWH’s perspectives. The study is grounded in Social Action Theory, a comprehensive social-cognitive/ecological model that allows for examination of changes in contextual influences (e.g., action contexts such as racism and homophobia; self-regulatory resources such as substance use), self-change processes (e.g., social interaction processes including social networks; motivational appraisals), and action states (e.g., attendance at HIV care appointments, substance use treatment [as needed], ART re-initiation). The study’s primary outcome is HIV viral suppression (VS). Two interconnected aims are proposed: to describe trajectories of engagement along the HCC (Aim 1), and guided by Social Action Theory, to identify, describe, and understand the contextual influences, self-change processes, and action states that impede or support the behaviors that comprise engagement along the HCC over time, including YEA-LWH’s perspectives on these factors (Aim 2). A Youth Advisory Board will be joined by scientific advisors to develop actionable recommendations based on study findings, which will be disseminated. Participants (N=270, half with HIV VS and half non-suppressed at enrollment) will be diverse African American/Black or Latinx behaviorally infected YEA-LWH recruited in New York City and Newark, NJ using a proven hybrid strategy. We will follow participants prospectively for 18 months using mixed methods, combining baseline and follow-up data (N ≈ 810 viral load observations), to assess the multifaceted domains expected to facilitate or impede engagement along the HCC, and YEA-LWH’s perspectives on their causes and meanings. The research team is expert in longitudinal mixed methods studies, HCC research, and AABL YEA. The proposed study aligns with NIH priorities and will advance solutions for this serious public health problem.