Latent class analysis of syndemic factors associated with HIV care outcomes among women living with HIV in the South

与南方艾滋病毒感染妇女艾滋病毒护理结果相关的综合症因素的潜在类别分析

• 批准号: 10483640
• 负责人: Jennifer Toller Erausquin
• 金额: $ 44.79万
• 依托单位: UNIVERSITY OF NORTH CAROLINA GREENSBORO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-13 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10483640
• 关键词: AIDS prevention; AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Behavior; Behavioral; Black race; Caring; Centers for Disease Control and Prevention (U.S.); Clinical Trials; Collaborations; Communities; Community Networks; Continuity of Patient Care; Country; Data; Data Sources; Death Rate; Development; Discrimination; Environment; Epidemic; Ethnic Origin; Ethnic group; Florida; Fostering; Foundations; Future; Gender; Geographic Locations; HIV; HIV diagnosis; Health; Hispanic; Incidence; Intervention; Latina; Medical; Mentorship; Mississippi; Monitor; National Institute of Mental Health; North Carolina; Not Hispanic or Latino; Outcome; Persons; Population Study; Prevention; Primary Health Care; Public Health; Qualitative Research; Race; Regression Analysis; Reporting; Research; Research Personnel; Resources; Risk; Strategic Planning; Structural Racism; Structure; Testing; Texas; United States National Institutes of Health; Universities; Unsafe Sex; Viral; Viral Load result; Virginia; Visit; Woman; Women' s Health; Women' s Role; antiretroviral therapy; base; biobehavior; care outcomes; cis-female; cis-male; comorbidity; design; disparity elimination; economic disparity; evidence base; experience; graduate student; health disparity populations; health inequalities; high risk; improved; member; men; mortality; multi-racial; population based; psychosocial; racial and ethnic; racial and ethnic disparities; secondary analysis; sex; sexual HIV transmission; social norm; social stigma; social structure; socioeconomics; syndemic; theories; therapy adherence; therapy development; tool; transgender women; transmission process; undergraduate research experience; undergraduate student

Abstract - New strategies are needed to understand the interplay of multiple barriers to HIV care engagement and viral suppression for diverse women living with HIV in the South. The South is a high-risk geographic area, with more than half of the new HIV diagnoses in the U.S., and incidence rates unchanged in a decade. Across the South, low resources, economic disparities, and racial/ethnic dynamics present challenges to ending the HIV epidemic. While research to date has identified factors independently associated with HIV care outcomes for women, our study will examine the simultaneous interplay of factors among women living with HIV in the South, in order to prioritize targets for intervention across racial/ethnic groups. Thus, the overall objectives of the proposed research are to: (1) examine psychosocial, structural, and behavioral comorbidities associated with three key outcomes along the HIV care continuum: (a) HIV care engagement, (b) viral suppression, and (c) biobehavioral transmission risk (condomless sex in the context of unsuppressed viral load); and (2) and to identify whether unique combinations of these comorbidities form syndemics that vary by race/ethnicity. We propose a secondary analysis of 2015-2019 data from the Medical Monitoring Project, a population-based study of persons living with HIV, focused on six Southern states: FL, GA, NC, MS, TX, and VA (N=~2,082). We have two Specific Aims. Aim 1 will quantitatively assess racial/ethnic disparities in HIV care engagement, viral suppression, and biobehavioral transmission risk among women in the six Southern states by (a) describing proportions of each outcome among Hispanic, non-Hispanic Black, non-Hispanic White, and other/multiracial women; (b) estimating associations between race/ethnicity, psychosocial, structural, and behavioral factors, and the three key outcomes; and (c) testing whether race/ethnicity moderates the association between psychosocial, structural, and behavioral factors and each of the three outcomes. Aim 2 will assess syndemic conditions experienced by women of different racial/ethnic groups by: (a) conducting latent class analyses to identify unique combinations of social and structural factors that may form a syndemic and that may vary by race/ethnicity, and (b) using regression analyses to test whether these emergent latent classes predict the three outcomes along the HIV Care Continuum. This R15 AREA study will strengthen the research environment by growing research mentorship, an academic-community network of collaborators, and a pipeline for quantitative research in health inequities and HIV at UNCG and will provide opportunities for active research involvement for undergraduate students with structured, collaborative mentorship throughout the project. Ultimately, this R15 AREA study will foster the development of evidence-based strategies to improve HIV care continuum outcomes by providing the foundational data to prioritize intervention strategies to address combinations of barriers experienced by diverse women in the South. Future clinical trials will test these potential interventions.

摘要-需要新的战略来理解艾滋病毒护理参与的多个障碍的相互作用 以及对南方艾滋病毒携带者的多样化妇女的病毒抑制。南方是一个高风险的地理区域， 美国新确诊的艾滋病毒病例有一半以上，发病率十年来没有变化。横穿 南方、低资源、经济差距和种族/民族动态对结束 艾滋病毒流行。虽然到目前为止的研究已经确定了与艾滋病毒护理结果独立相关的因素 对于妇女，我们的研究将检查感染艾滋病毒的妇女中各种因素的同时相互作用。 在南方，以便确定各种族/族裔群体干预的优先目标。因此，总的目标是 建议的研究是：(1)检查与心理社会、结构和行为并存相关的 在艾滋病毒护理连续统一体中有三个关键成果：(A)艾滋病毒护理参与，(B)病毒抑制，以及 (C)生物行为传播风险(在病毒载量未受抑制的情况下发生无避孕套的性行为)；及 确定这些共病的独特组合是否形成了因种族/民族而异的综合体。我们 建议对2015-2019年医疗监测项目的数据进行二次分析，这是一项以人口为基础的 对艾滋病毒携带者的研究集中在六个南方州：FL、GA、NC、MS、TX和VA(N=~2,082)。 我们有两个具体目标。目标1将定量评估艾滋病毒护理中的种族/民族差异 南方六州女性的参与度、病毒抑制和生物行为传播风险 通过(A)描述西班牙裔、非西班牙裔黑人、非西班牙裔白人和 其他/多种族妇女；(B)估计种族/族裔、心理社会、结构性和 行为因素和三个关键结果；以及(C)测试种族/民族是否会缓和 心理社会因素、结构因素和行为因素与三种结果之间的关系。目标2 将通过以下方式评估不同种族/族裔群体的妇女所经历的合并症： 潜在阶级分析，以确定可能形成共性的社会和结构性因素的独特组合 这可能会因种族/民族而异，以及(B)使用回归分析来测试这些新出现的潜在 班级们预测了艾滋病毒护理连续体的三个结果。 这项R15领域的研究将通过加强研究指导，以及 学术-社区合作者网络，以及卫生不平等和卫生领域定量研究的渠道 并将为本科生提供积极参与研究的机会 在整个项目中提供结构化、协作性的指导。最终，这项R15区域研究将促进 制定循证战略，通过提供 基础数据用于确定干预策略的优先顺序，以解决以下方面遇到的障碍组合 南方多样化的女性。未来的临床试验将测试这些潜在的干预措施。