Improving engagement in HIV care for high-risk women

提高高危女性艾滋病毒护理的参与度

• 批准号: 8992854
• 负责人: Jae M. Sevelius
• 金额: $ 95.53万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-08 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8992854
• 关键词: Adherence; Adult; Alcohol or Other Drugs use; Appointment; Behavioral; Belief; Biological Assay; Birth; Caring; Communities; Complex; Control Groups; Coping Skills; Critical Care; Drug Interactions; Educational workshop; Enrollment; Expectancy; Face; Failure; Focus Groups; Fright; Gender; HIV; Health; Health Personnel; Healthcare; High Risk Woman; Hormones; Individual; Injection of therapeutic agent; Intervention; Interview; Lead; Life; Los Angeles; Medical; Mental disorders; Misinformation; Modeling; Morbidity - disease rate; Outcome; Patient Self-Report; Patients; Pattern; Pharmaceutical Preparations; Population; Primary Health Care; Professional counselor; Provider; Psyche structure; Public Health; Randomized; Randomized Controlled Trials; Reporting; Research; Research Personnel; Risk; Risk Factors; San Francisco; Self Efficacy; Sexual Partners; Shelter facility; Silicones; Site; Social support; Substance abuse problem; Surveys; Treatment Efficacy; Treatment Failure; Viral; Viral Load result; Viral load measurement; Work; antiretroviral therapy; base; clinical care; coping; design; empowerment; experience; follow-up; health care model; high risk; hormone therapy; improved; indexing; intervention effect; male; meetings; mortality; novel; peer; prevent; primary outcome; public health relevance; response; satisfaction; sex; social stigma; stem; theories; therapy adherence; therapy development; transgender; transgender women; transmission process; treatment as usual; trial comparing; uptake

 DESCRIPTION (provided by applicant): Transgender women (assigned `male' at birth but who do not identify as male) are disproportionately impacted by HIV and have culturally unique barriers and facilitators to engagement in HIV care. Transgender women living with HIV (TWH) are less likely than others to take antiretroviral therapy (ART), and those who initiate ART have lower rates of ART adherence, lower self-efficacy for integrating ART into daily routines, and report fewer positive interactions with health care providers than non-transgender adults. As a result, TWH have an almost three-fold higher viral load than non-transgender adults in San Francisco; in Los Angeles, TWH are less likely to be virally suppressed than any other behavioral risk group. In our formative work, we have identified culturally-specific and modifiable barriers to HIV treatment engagement among TWH, including prioritization of transition-related health care (i.e. hormone therapy) at the expense of HIV treatment, avoidance of HIV care settings due to past negative health care experiences, misinformation about ART including potential drug interactions with hormones, intensified HIV stigma, low levels of social support, and poor coping skills. There are both individual and public health consequences to poor engagement in care among TWH stemming from high transmission risk factors, including substance abuse, high numbers of sex partners, engagement in sex work, and high rates of mental illness. These findings strongly suggest that TWH face unique challenges to engaging in and adhering to HIV treatment, and that the public health consequences for poor engagement in this population are of grave concern. Interventions to mitigate these barriers to engagement in care are critical in efforts to alter the pattern of HIV-related disparities that lead to disproportionately poor health outcomes for this highly vulnerable and marginalized population. We propose a randomized controlled trial of a theory- driven, population-specific, piloted intervention to improve engagement in care for TWH. Grounded in the investigators' Models of Gender Affirmation and Health Care Empowerment, the proposed research is the first to systematically intervene on complex barriers to optimal engagement in HIV care for TWH. We have developed and piloted the Healthy Divas intervention to optimize engagement in HIV care for TWH at elevated risk for treatment failure and consequential morbidity, mortality, and transmission of HIV.

 描述（由申请人提供）：跨性别妇女（出生时被指定为“男性”，但不确定为男性）受到艾滋病毒的影响不成比例，并且在参与艾滋病毒护理方面具有独特的文化障碍和促进因素。感染艾滋病毒的跨性别妇女（TWH）比其他人更不可能接受抗逆转录病毒治疗（ART），而那些开始ART的人坚持ART的比例较低，将ART纳入日常生活的自我效能较低，并且报告与非跨性别成年人相比，与医疗保健提供者的积极互动较少。因此，在旧金山弗朗西斯科，TWH的病毒载量几乎是非变性成年人的三倍;在洛杉矶，TWH比任何其他行为风险群体都不太可能受到病毒抑制。在我们的形成工作中，我们已经确定了文化特定的和可修改的 艾滋病毒感染者中艾滋病毒治疗参与的障碍，包括以艾滋病毒治疗为代价优先考虑与过渡相关的医疗保健（即激素治疗），由于过去的负面医疗保健经历而避免艾滋病毒护理环境，关于ART的错误信息，包括潜在的药物与激素的相互作用，艾滋病毒污名化加剧，社会支持水平低，以及应对技能差。由于高传播风险因素，包括药物滥用、性伴侣数量多、从事性工作和精神疾病发病率高，TWH中护理参与不足对个人和公共健康都有影响。这些研究结果强烈表明，TWH面临着独特的挑战，参与和坚持艾滋病毒治疗，以及在这一人群中参与不良的公共卫生后果是严重关切的。采取干预措施，减少这些参与护理的障碍，对于努力改变艾滋病毒相关不平等的模式至关重要，这种模式导致这一高度脆弱和边缘化的人口的健康结果不成比例地差。我们提出了一个随机对照试验的理论驱动的，特定人群的，试点干预，以提高参与护理TWH。基于研究人员的性别肯定和卫生保健赋权模型，拟议的研究是第一个系统地干预复杂的障碍，以最佳地参与TWH的艾滋病毒护理。我们已经制定并试行了健康女神干预措施，以优化对TWH的艾滋病毒护理参与，这些TWH具有治疗失败和随之而来的发病率，死亡率和艾滋病毒传播的高风险。