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 - 需要新的策略来了解艾滋病毒护理参与的多重障碍的相互作用 以及对南方感染艾滋病毒的不同妇女进行病毒抑制。南方是高风险地理区域， 美国一半以上新诊断出艾滋病毒，而且发病率十年来没有变化。穿过 南方、资源匮乏、经济差距和种族/族裔动态给结束这种现象带来了挑战 艾滋病毒流行。虽然迄今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 对于女性来说，我们的研究将考察感染艾滋病毒的女性中各种因素的同时相互作用。 南方，以便优先考虑跨种族/族裔群体的干预目标。因此，总体目标 拟议的研究是：（1）检查相关的心理社会、结构和行为合并症 艾滋病毒护理连续过程中具有三个关键成果：(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进行无安全套性行为）；和 (2) 和 确定这些合并症的独特组合是否会形成因种族/民族而异的综合征。我们 建议对医疗监测项目 2015-2019 年的数据进行二次分析，该项目是一项基于人口的项目 针对艾滋病毒感染者的研究，重点关注南部六个州：佛罗里达州、佐治亚州、北卡罗来纳州、密西西比州、德克萨斯州和弗吉尼亚州（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 南部六个州女性的参与度、病毒抑制和生物行为传播风险 (a) 描述西班牙裔、非西班牙裔黑人、非西班牙裔白人中每种结果的比例，以及 其他/多种族女性； (b) 估计种族/族裔、社会心理、结构和社会因素之间的关联 行为因素和三个关键结果； (c) 测试种族/民族是否会调节 社会心理、结构和行为因素与这三个结果之间的关联。目标2 将通过以下方式评估不同种族/族裔群体的妇女经历的流行病状况： (a) 进行 潜在类别分析，以确定可能形成流行病的社会和结构因素的独特组合 并且这可能因种族/民族而异，并且（b）使用回归分析来测试这些新兴的潜在因素是否存在 课程预测艾滋病毒护理连续体的三个结果。 这项 R15 AREA 研究将通过加强研究指导来加强研究环境， 学术界合作者网络，以及健康不平等和健康问题定量研究的渠道 UNCG 的艾滋病毒研究将为患有艾滋病毒的本科生提供积极参与研究的机会 整个项目的结构化、协作式指导。最终，这项 R15 AREA 研究将促进 制定基于证据的战略，通过提供 确定干预策略优先顺序的基础数据，以解决所经历的障碍组合 南方的女性多元化。未来的临床试验将测试这些潜在的干预措施。