Understanding burden and lived experience of diabetes and hypertension among women living with HIV in the Dominican Republic to improve care integration

了解多米尼加共和国艾滋病毒感染者的糖尿病和高血压负担和生活经历，以改善护理一体化

• 批准号: 10538201
• 负责人: CLARE L BARRINGTON
• 金额: $ 21.05万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10538201
• 关键词: Acute; Adult; Aging; Caribbean region; Caring; Cessation of life; Chronic; Communicable Diseases; Country; Decentralization; Development; Diabetes Mellitus; Diagnosis; Discrimination; Disease; Dominican; Dominican Republic; Educational workshop; Environmental Risk Factor; Epidemiology; Face; Focus Groups; Gender; Goals; Government; HIV; Health; Health Services Accessibility; Healthcare; Healthcare Systems; Hypertension; Inequality; Interruption; Interview; Latin America; Life; Life Style; Mental Depression; Mental Health; Methods; Modeling; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Patients; Personal Satisfaction; Persons; Population; Population Sizes; Poverty; Prediabetes syndrome; Prevalence; Provider; Qualitative Research; Research; Risk; Risk Factors; Self Management; Series; Site; Stress; System; Treatment outcome; Violence; Viral; Vulnerable Populations; Woman; antiretroviral therapy; cardiometabolic risk; care costs; care outcomes; care providers; cis-female; cohort; coping; cost; experience; female sex worker; improved; informant; insight; low and middle-income countries; mortality; multiple chronic conditions; negative affect; public health relevance; sex; social stigma; stakeholder perspectives; substance use

Project Summary/Abstract: The health context across many low-and-middle-income countries reflects the “epidemiologic transition”, or the shift from higher mortality and morbidity attributable to acute, infectious disease to a higher burden of noncommunicable diseases (NCD). As a result of this transition, countries across Latin America and the Caribbean (LAC) increasingly face a triple burden including: 1) ongoing infectious diseases; 2) increasing NCD; and 3) mental health challenges, including substance use. The triple burden is unevenly distributed with certain populations experiencing disproportionate burden relative to their population size. One particularly vulnerable population is female sex workers (FSW), or cisgender women who consensually exchange sex for money or other goods. Global HIV prevalence among FSW is 10.4% compared to 0.7% among adults worldwide. In the Dominican Republic (DR), the site of the proposed study, adult HIV prevalence is 0.9% compared to 4.2% among FSW. In a cohort of FSW living with HIV in Santo Domingo, our team has documented viral suppression levels ranging from 51% to 73%. Determinants of poor HIV treatment outcomes include depression, substance use, anti-retroviral therapy interruption, and various forms and types of stigma, reflecting the embodiment of the triple burden among FSW living with HIV in this setting. Despite sub-optimal levels of viral suppression, many FSW in the DR access care and treatment through a system of decentralized care centers and live with HIV as a chronic condition. As a result, they are vulnerable to NCD associated with HIV, aging, and environmental factors, in particular type-2 diabetes (T2D) and hypertension (HTN). An estimated 10% of Dominican adults have T2D and 31% HTN. There is no systematic research about NCD among FSW nor understanding of how FSW living with HIV navigate a healthcare system with limited sensitization to their context and needs in the DR or elsewhere. The proposed study aims to improve understanding of the burden of NCD among FSW living with HIV in Santo Domingo. Specific aims are: Aim 1: Describe type 2 diabetes (T2D) and hypertension (HTN) prevalence among sex workers with HIV. For Aim 1, we will re-engage our cohort of FSW living with HIV in Santo Domingo (n=200) to screen for T2D/HTN and assess determinants. Aim 2: Explore the lived experience of multiple chronic conditions among FSW with HIV and T2D/HTN. For Aim 2, we will conduct qualitative in-depth interviews with FSW previously diagnosed with T2D/HTN (n=25) to explore their experiences with healthcare, self-management, mental health, and wellbeing. Aim 3: Identify provider and stakeholder perspectives on integration of care for HIV and T2D/HTN. For Aim 3, we will conduct key informant interviews with providers and stakeholders (n=25) to assess the landscape of HIV and T2D/HTN care and probe on opportunities for integration. We will also facilitate a series of focus groups (n=3) and collaborative workshops to develop a model of integrated care in a collaborative and participatory manner.

项目概要/摘要： 许多低收入和中等收入国家的健康状况反映了“流行病学转变”，或 从急性传染病造成的较高死亡率和发病率转变为 非传染性疾病（NCD）。由于这一过渡，拉丁美洲和加勒比国家 加勒比地区（LAC）日益面临三重负担，包括：1）持续的传染病; 2）不断增加的 非传染性疾病; 3）心理健康挑战，包括物质使用。三重负担分布不均， 某些人口承受着与其人口规模不成比例的负担。一个特别 弱势群体是女性性工作者（FSW），或自愿以性行为交换性行为的顺性别女性 钱或其他物品。女性性工作者的全球艾滋病毒感染率为10.4%，而成年人为0.7% 国际吧在多米尼加共和国（DR），建议的研究地点，成人艾滋病毒感染率为0.9% 相比之下，FSW的这一比例为4.2%。在圣多明各的一群感染艾滋病毒的FSW中，我们的团队 记录的病毒抑制水平范围为51%至73%。艾滋病毒治疗效果不佳的决定因素 包括抑郁症、药物使用、抗逆转录病毒疗法中断以及各种形式和类型耻辱， 这反映了感染艾滋病毒的女性性工作者在这种情况下的三重负担。尽管次优 在病毒抑制水平方面，DR中的许多FSW通过分散的系统获得护理和治疗。 护理中心和艾滋病毒作为一种慢性疾病生活。因此，他们很容易患上非传染性疾病， HIV、衰老和环境因素，特别是2型糖尿病（T2 D）和高血压（HTN）。一个 估计10%的多米尼加成年人患有T2 D，31%患有HTN。关于非传染性疾病的系统研究尚不多见 也不了解感染艾滋病毒的FSW如何在医疗保健系统中导航， 对他们在DR或其他地方的背景和需求的敏感性。这项研究旨在改善 了解圣多明各感染艾滋病毒的女性性工作者的非传染性疾病负担。具体目标是：目标1： 描述感染艾滋病毒的性工作者中2型糖尿病（T2 D）和高血压（HTN）的患病率。为 目标1，我们将重新招募圣多明各感染艾滋病毒的FSW队列（n=200），以筛查T2 D/HTN 并评估决定因素。目的二：探讨多个慢性病患者的生活经验， 患有HIV和T2 D/HTN的FSW。就目标2而言，我们将在之前与FSW进行定性深入访谈， 诊断为T2 D/HTN（n=25），以探索他们在医疗保健、自我管理、心理健康 和幸福目标3：确定提供者和利益攸关方对艾滋病毒和艾滋病护理一体化的看法， T2D/HTN。对于目标3，我们将与供应商和利益相关者（n=25）进行关键线人访谈， 评估艾滋病毒和T2 D/HTN护理的前景，并探讨整合的机会。我们还将 促进一系列焦点小组（n=3）和协作研讨会，以制定一个综合护理模式， 合作和参与的方式。