Complementary & Alternative Care Behavior in HIV+ Latinos in the US-Mexico

补充

• 批准号: 7918993
• 负责人: Maria Luisa Zuniga de Nuncio
• 金额: $ 15.69万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7918993
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Ally; Behavior; Behavior Therapy; Caring; Characteristics; Communication; Communities; Complementary and alternative medicine; Development; Disclosure; Disease; Face; Future; Goals; HIV; HIV Seropositivity; Healed; Health; Health Insurance; Health Personnel; Health Services Accessibility; Health system; Healthcare; Improve Access; Intervention; Interview; Interviewer; Knowledge; Latino; Lead; Life; Medicine; Mexico; Modality; Nature; Outcome; Patients; Perception; Pharmacists; Pharmacy facility; Physicians; Phytotherapy; Population; Provider; Reaction; Religion and Spirituality; Reporting; Research; Sampling; Services; Side; Spirituality; Staging; Stigmata; Surveys; System; United States; Work; antiretroviral therapy; care delivery; care seeking; community based participatory research; effective intervention; experience; healing; health care service utilization; health disparity; improved; public health relevance; research study; response; satisfaction; social stigma; therapy adherence

DESCRIPTION (provided by applicant): The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos in the United States (US) - Mexico border region. HIV-positive Latinos in the US face substantial health disparities when compared to non- Latino Whites, including delayed care entry/entering care with advanced HIV disease and they are disproportionately impacted by HIV-stigma and poor patient-provider communication. CAM use (e.g. herbal therapies, alternative healers, and spirituality/religious practices) may be implicated in disparities (e.g. low antiretroviral therapy (ARVs) adherence). Study aims and hypotheses are: Aim 1: To assess CAM-specific health care behavior, including bi-national CAM utilization from allied/alternative health personnel (e.g. pharmacists, non-Western medicine healers) among HIV-positive Latinos residing in Tijuana and San Diego. Hypothesis 1 (H1) Greater use of CAM will be observed among HIV-positive Latinos who report a) crossing the U.S. border more frequently, and b) having migrated to Tijuana or San Diego (e.g. from southern Mexico). Aim 2: To assess use of CAM in the context of HIV treatment utilization and practices, including factors related to delayed entry into HIV care (e.g. HIV stigma); and utilization of and adherence to ARVs among HIV-positive Latinos residing in Tijuana or San Diego. H2.a) Compared to HIV-positive Latinos who report using herbal CAM, those who do not use herbal CAM are more likely to be receiving ARVs and report higher levels of adherence to ARVs; H2.b) Compared to HIV-positive Latinos who do not attend religious services regularly, those who attend religious services regularly are more likely to be receiving ARV; H2.c) Compared to HIV- positive Latinos who report experiencing HIV-related stigma, those who do not report experiencing HIV-related stigma are significantly more likely to be receiving ARV. Aim 3: To determine perceived barriers to communicating use of CAM and ARV adherence to clinicians among HIV-positive Latinos residing in Tijuana or San Diego, including satisfaction with clinician communication, concern about clinician response to reporting CAM use and perception of ARV efficacy; H3) Among CAM users, disclosure of CAM use will be higher among Latino patients who report higher satisfaction with clinician communication than among those who report lower satisfaction. Aim 4: To explore provider and system barriers to culturally-effective communication about CAM and ARV adherence in HIV+ Latinos. In Aims 1-3 we will conduct quantitative, interviewer-administered surveys with 200 HIV+ Latinos (100 from each side of the border). Aim 4 will assess clinician perspectives on CAM through interviews with 20 HIV clinicians on both sides of the border. This study will reduce health disparities in US Latinos by improving culturally-effective clinician communication and will lead to interventions to increase adherence to ARVs and improved health outcomes. PUBLIC HEALTH RELEVANCE: The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos on the San Diego/Tijuana border. CAM use among US Latinos living with HIV is associated with delayed utilization of and poor adherence to antiretroviral therapies (ARVs) that may exacerbate health disparities in HIV care access and health outcomes. This study will lead to development of culturally-effective interventions to improve access and adherence to HIV care in Latinos who face health disparities.

描述（由申请人提供）：我们以社区为基础的参与性研究的目标是确定在美国（US）-墨西哥边境地区艾滋病毒阳性拉丁美洲人中补充和替代医学（CAM）使用的性质和程度。与非拉丁裔白人相比，美国的艾滋病毒阳性拉丁裔面临着巨大的健康差距，包括延迟进入护理/进入晚期艾滋病毒疾病的护理，他们受到艾滋病毒污名和患者与提供者沟通不良的不成比例的影响。CAM的使用（如草药疗法、替代疗法和灵性/宗教实践）可能与差异有关（如抗逆转录病毒疗法坚持率低）。研究目的和假设是：目标1：评估CAM特定的医疗保健行为，包括居住在蒂华纳和圣地亚哥的HIV阳性拉丁美洲人中的联合/替代卫生人员（例如药剂师，非西医治疗师）的两国CAM利用率。假设1（H1）在报告a）更频繁地穿越美国边境和B）已迁移到蒂华纳或圣地亚哥（例如从墨西哥南部）的艾滋病毒阳性拉丁美洲人中，将观察到更多的CAM使用。目标二：评估CAM在HIV治疗利用和实践背景下的使用情况，包括与延迟进入HIV护理相关的因素（例如HIV污名化）;以及居住在蒂华纳或圣地亚哥的HIV阳性拉丁美洲人中抗逆转录病毒药物的利用和坚持。H2.a）与报告使用草药CAM的艾滋病毒阳性拉丁美洲人相比，不使用草药CAM的人更有可能接受抗逆转录病毒药物，并报告更高水平的抗逆转录病毒药物依从性; H2.b）与不定期参加宗教服务的艾滋病毒阳性拉丁美洲人相比，定期参加宗教服务的人更有可能接受抗逆转录病毒药物; H2.c）与报告经历艾滋病毒相关耻辱的艾滋病毒阳性拉丁美洲人相比，那些没有报告经历艾滋病毒相关耻辱的人更有可能接受抗逆转录病毒治疗。目标3：确定居住在蒂华纳或圣地亚哥的HIV阳性拉丁美洲人与临床医生沟通使用CAM和ARV依从性的感知障碍，包括对临床医生沟通的满意度，对临床医生报告CAM使用的反应的担忧以及对ARV疗效的感知; H3）在CAM用户中，报告对临床医生沟通满意度较高的拉丁裔患者的CAM使用披露率高于报告对临床医生沟通满意度较低的患者。满意目的4：探讨艾滋病毒阳性拉丁美洲人对CAM和ARV依从性的文化有效沟通的提供者和系统障碍。在目标1-3中，我们将对200名艾滋病毒阳性拉丁美洲人（边境两侧各100名）进行定量、访谈管理的调查。目标4将通过与边境两侧的20名艾滋病毒临床医生的访谈，评估临床医生对CAM的看法。这项研究将通过改善文化有效的临床医生沟通来减少美国拉丁美洲人的健康差异，并将导致干预措施，以增加对ARV的依从性和改善健康结果。公共卫生相关性：我们以社区为基础的参与性研究的目标是确定在圣地亚哥/蒂华纳边境的艾滋病毒阳性拉丁美洲人中使用补充和替代医学（CAM）的性质和程度。在美国拉丁裔艾滋病毒感染者中，CAM的使用与抗逆转录病毒疗法（ARV）的延迟使用和依从性差有关，这可能会加剧艾滋病毒护理获得和健康结果的健康差距。这项研究将导致发展文化有效的干预措施，以改善获得和坚持艾滋病毒护理的拉丁美洲人谁面临的健康差距。