Women-centered HIV care practices that facilitate HIV care retention and viral suppression in the presence of adverse sociocultural factors

以妇女为中心的艾滋病毒护理实践，有助于在存在不利社会文化因素的情况下保留艾滋病毒护理和抑制病毒

• 批准号: 9925657
• 负责人: MARY JO TREPKA
• 金额: $ 54.03万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-12 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9925657
• 关键词: AIDS/HIV problem; Address; Adherence; Administrator; Affect; African American; Alcohol or Other Drugs use; Anti-Retroviral Agents; Area; Behavioral Model; Caring; Case Manager; Child Care; Client; Color; Communities; County; Cuban; Data; Device or Instrument Development; Drug usage; Enrollment; Epidemic; Ethnic Origin; Evaluation; Face; Gender; Goals; HIV; HIV Infections; HIV diagnosis; Haitian; Health; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; Immigrant; Immigration; Individual; Intake; International; Interview; Laboratories; Language; Latina; Mental Depression; Methods; Minority; Minority Recruitment; Neighborhoods; Outcome; Patient-Centered Care; Patients; Policies; Poverty; Provider; Race; Research; Surveys; System; Treatment outcome; United States; United States National Institutes of Health; Viral; Woman; Women' s Health; antiretroviral therapy; billing data; care burden; care delivery; care outcomes; care systems; design; disparity reduction; ethnic minority population; experience; health disparity; improved; improved outcome; instrument; low socioeconomic status; men; metropolitan; mortality; multilevel analysis; programs; racial and ethnic; racial minority; retention rate; social culture; social stigma; success; therapy adherence; transmission process; treatment disparity

PROJECT SUMMARY Achieving high rates of retention in human immunodeficiency virus (HIV) care and adherence to antiretroviral therapy leads to high rates of viral suppression, which not only reduces mortality and improves quality of living, among people living with HIV infection, but also reduces HIV transmission within affected communities. HIV care outcomes among women have been suboptimal; in 2014, viral suppression was 52.6% among African Americans, 57.9% among Whites, and 59.8% among Latinas compared with 66.0% among White men. Women living with HIV infection are more likely to face barriers to successful HIV care such as child care burden, abuse, and extreme poverty than men. In addition, women, in particular women of color, can face multiple layers of stigma including those related to their race, ethnicity, HIV infection, drug use, and poverty status. Partly because the HIV epidemic initially affected mostly men, the HIV care system is not designed to meet women's special needs. Implementing women-centered HIV care has been proposed nationally and internationally as a way to address women's needs. However, this idea has not been well operationalized for HIV care and has not been examined in the context of the United States health care system including the Ryan White Program, which serves 65% of women living with HIV in the United States. Our central hypothesis is that the more women-centric a system is, the higher the likelihood of HIV care retention and viral suppression among women. The objective of this application is to identify effective provider and system women-centered HIV care practices within the Ryan White Program that positively influence HIV care retention and viral suppression among women experiencing sociocultural challenges. We will accomplish this objective with a mixed methods study examining patient intake and billing data from women enrolled in the Miami-Dade County Ryan White Program, conducting in-depth interviews with case managers, health care providers, administrators, and women living with HIV, and conducting a survey of 600 women living with HIV in the Miami- Dade County Ryan White Program. We propose the following three specific aims: 1) Identify sociocultural factors that influence HIV care retention and viral suppression, including those unique to women and those having a differential impact on African American, Haitian and Latina women; 2) Ascertain current and potential health care provider and system women-centered HIV care practices that may mitigate the effect of adverse sociocultural factors on HIV care retention and antiretroviral therapy adherence; 3) Identify specific health care provider and system women-centered HIV care practices that most strongly influence HIV care retention, adherence, and viral suppression among all women and in African American, Haitian and Latina women. This project addresses the National HIV/AIDS Strategy goals to increase access to care, improve health outcomes, and reduce HIV-related health disparities and the Trans-NIH Plan for HIV-Related Research call for research to promote HIV care engagement and to reduce disparities in treatment outcomes.

项目摘要 达到人类免疫缺陷病毒（HIV）护理的高度保留率和对抗逆转录病毒的依从性 治疗导致病毒抑制率高，这不仅降低了死亡率并提高生活质量，而且还可以 在感染艾滋病毒感染的人中，但也减少了受影响社区内的艾滋病毒传播。艾滋病病毒 妇女的照顾结果是次优的。 2014年，非洲的病毒抑制为52.6％ 美国人中的白人为57.9％，在拉丁裔中为59.8％，而白人中有66.0％。 感染艾滋病毒感染的妇女更有可能面临成功的艾滋病毒护理障碍，例如托儿服务 负担，虐待和极端贫困。此外，女性，特别是有色女性，可以面对 多层污名包括与种族，种族，艾滋病毒感染，毒品使用和贫困有关的污名 地位。部分是因为艾滋病毒的流行最初受到男性的影响，艾滋病毒护理系统并非旨在 满足妇女的特殊需求。在全国范围内提出了以女性为中心的艾滋病毒护理的人 国际上是解决妇女需求的一种方式。但是，这个想法还没有得到很好的运作 HIV护理，尚未在包括Ryan在内的美国医疗保健系统的背景下进行检查 怀特计划为美国65％的艾滋病毒妇女提供服务。我们的中心假设是 以女性为中心的系统的系统越多，艾滋病毒护理保留和病毒抑制的可能性越高 在女性中。该应用的目的是确定以女性为中心的有效提供商和系统 Ryan White计划中的HIV护理惯例积极影响HIV护理保留和病毒 在经历社会文化挑战的妇女中受到压制。我们将通过 混合方法研究检查了迈阿密戴德县入学的妇女的患者摄入量和计费数据 瑞安·怀特计划（Ryan White）计划，对病例经理，卫生保健提供者进行深入的访谈， 行政人员和艾滋病毒感染的妇女，并对迈阿密的600名妇女进行调查 达德县瑞安·怀特计划。我们提出以下三个具体目标：1）确定社会文化 影响艾滋病毒护理保留和病毒抑制的因素，包括女性和那些独有的因素 对非裔美国人，海地和拉丁裔妇女产生不同的影响； 2）确定电流和潜力 医疗保健提供者和系统以女性为中心的艾滋病毒护理实践，可能会减轻不良影响 艾滋病毒护理保留和抗逆转录病毒疗法的社会文化因素； 3）确定特定的医疗保健 提供者和系统以女性为中心的艾滋病毒护理实践，最强烈影响艾滋病毒护理保留率， 所有妇女以及非裔美国人，海地和拉丁裔妇女的依从性和病毒抑制。这 项目解决了国家艾滋病毒/艾滋病战略目标，以增加获得护理的机会，改善健康成果， 并减少与HIV相关的健康差异以及与HIV相关研究呼吁进行研究的Trans-NIH计划 促进艾滋病毒护理参与并减少治疗结果的差异。