Determinants of self-reported health and well-being outcomes among people living with HIV in the UK: a mixed-methods exploration of the impact of stru

在过去的二十年里，英国对人类免疫缺陷病毒(HIV)携带者的治疗和护理有了显著的改善。这些进步意味着人们可以在一生中的大部分时间里感染艾滋病毒，几乎没有并发症；它是一种“慢性”(或终生)疾病，被认为是“无法检测到的”。然而，诊断的临床阶段以及人们如何处理与艾滋病毒并存的其他健康状况(共病)的差异仍然存在。艾滋病毒携带者还描述了在提供的社会和福利服务方面未得到满足的需求，其中包括移民或就业支助等服务，其资金受到最近政府政策变化的影响。该项目旨在调查为什么艾滋病毒携带者的健康和福祉存在差异，以及人们的经济和社会环境(他们的社会决定因素)可以在多大程度上解释这种差异。我们还将探索最近公共政策的变化，包括那些与报道中的移民“敌对环境”相关的变化，是否也影响了英国艾滋病毒携带者在获得社会和福利服务时面临的体验。我们将使用两种主要方法来探索这些差异；首先，分析2017年英国公共卫生(PHE)对4000多名艾滋病毒携带者进行的调查数据，即积极声音研究。其次，我们将深入采访艾滋病毒携带者以及其他主要利益攸关方，包括社区组织、服务提供者和政策制定者。我们将与艾滋病毒携带者组成的顾问小组密切合作，帮助指导我们的研究发展，他们将参与研究的每个步骤-设计我们的方法，指导分析和解释，并传播结果。研究结果将与我们在公共卫生署的合作者分享，为未来的政策提供证据，并为临床护理提供信息，以改善艾滋病毒携带者获得医疗和社会护理服务的体验，以及支持艾滋病毒携带者的最终用户组织。

The treatment and care of people living with HumanImmunodeficiency Virus (HIV) has significantly improved inthe past two decades across the United Kingdom (UK).These advancements now mean that people can live with HIVfor much of their life, with few complications; it is a "chronic"(or lifelong) condition and is considered 'beyondundetectable'. Yet, differences in clinical stage at diagnosisand how people manage their other health conditions (comorbidities) alongside HIV still exist. People living with HIVhave also described an unmet need in social and welfareservices being provided, which includes services such asimmigration or employment support, and whose funding hasbeen affected by recent changes in government policies.This project looks to investigate why differences exist for thehealth and wellbeing of people living with HIV, and how muchthis can be explained by peoples' economic and socialcircumstances (their social determinants). We will alsoexplore whether recent changes in public policies, includingthose related to the reported "hostile environment" forimmigration, have also affected the experiences faced bypeople living with HIV when accessing social and welfareservices in the UK.We will use two main methods to explore these differences;firstly, analysing data from a survey conducted in 2017 byPublic Health England (PHE) of over 4,000 adults living withHIV in the UK, the Positive Voices study. Secondly, we willconduct in-depth interviews with people living with HIV as wellas other key stakeholders including communityorganisations, service providers and policy makers. We willwork closely with an advisory group of people living with HIVto help guide our research as it develops, and who will beinvolved in each step of the study - designing our approach,guiding analysis and interpretation, and disseminatingresults.The findings will be shared with our collaborators at PHE toprovide evidence for future policy and to inform clinical carein order to improve the experience of people living with HIVaccessing health and social care services as well as end-userorganisations that support people living with HIV.