Impact of multiple stigmas on HIV care continuum outcomes for key populations

多重耻辱对重点人群艾滋病毒护理连续结果的影响

• 批准号: 9979953
• 负责人: Viraj V Patel
• 金额: $ 21.85万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-17 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9979953
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adopted; Anti-Retroviral Agents; Anxiety; Area; Attitude; Caring; Clinical; Communities; Continuity of Patient Care; Coping Skills; Country; Data; Discrimination; Epidemic; Face; Fibrinogen; Fright; Future; Gender; Gender Identity; Goals; HIV; Health; India; Infrastructure; Intervention; Link; Literature; Mediating; Mediator of activation protein; Mental Depression; Mental Health; Methods; NIH Office of AIDS Research; Newly Diagnosed; Nongovernmental Organizations; Outcome; PHEMX gene; Perception; Phase; Population; Prevalence; Prospective cohort study; Public Health; Research; Research Design; Research Priority; Resources; Services; Sexuality; Social support; Stigmatization; Target Populations; Testing; Time; Treatment outcome; United States; Viral; Woman; base; care seeking; cohort; design; expectation; experience; global health; improved; innovation; male health; men who have sex with men; programs; psychologic; response; service providers; sexual identity; social stigma; therapy development; transgender women

Background: Globally, stigma continues to be a major barrier to engage and retain PLWH in care. The goal of this proposal is to understand the impact of multiple stigmas on antiretroviral (ART) initiation and retention in care among men who have sex with men (MSM) and transwomen (TW) living with HIV (MSM/TW+H) in India. India has the third largest HIV burden in the world, and the epidemic disproportionately impacts MSM/TW. Key (stigmatized) populations such as MSM/TW+H, are more likely to have poor HIV treatment outcomes, resulting in rates of ART initiation/retention and viral suppression that are unacceptably low to achieve UNAIDS 90-90- 90 goals. In India, MSM and TW women, though two distinct populations, face similar gender or sexual-identity and HIV-related stigmas, which may: (1) directly discourage HIV care engagement and (2) indirectly reduce capacity for HIV care engagement via mediators such as poor mental health (depression/anxiety), psychological resources (e.g. poor coping skills), and interpersonal factors (e.g. lack of social support). Studying stigma and its mediational paths to HIV outcomes are needed. Methods: This R21 study, responsive to PA 18-277,"studies designed in partnership with service providers ... to understand factors impacting ART initiation... retention," is an innovative collaborative community research partnership with India's largest community-based HIV service provider. It is designed to leverage the agency's robust service and tracking infrastructure to conduct a longitudinal prospective cohort study of stigma, associated clinical outcomes (ART initiation and retention at 6 months), and potential mediators in 370 MSM­-TW+H (185 MSM/TW each). Guided by the HIV Stigma Framework, our Aims are to: 1) Characterize the prevalence and change over time of multiple stigmas in a cohort of newly diagnosed Indian MSM/TW+H. This will also involve exploring potential differences in levels and types of stigmas between MSM and TW to inform future intervention development. 2) Examine the longitudinal direct and indirect (via mental health, interpersonal factors, and psychological resources) effects of stigmas on a) ART initiation by 3 months and b) retention in ART care at 6 months. We will also explore differences in the magnitude of effects across different stigmas for each outcome to better understand which are the strongest targets for future interventions. We will additionally conduct exploratory analyses to a) examine differences in these effects for MSM versus TW; and b) identify how future interventions can be tailored to meet the needs of each group. Potential Impact. While global health agencies are calling to reduce HIV and MSM/TW stigma, no effective and scalable interventions exist that address multiple stigmas among MSM/TW+H to improve HIV care continuum outcomes. This study will provide the needed empirical data about the multiple stigmas faced by MSM/TW+H, these stigmas' influence on ART initiation/retention, and potential modifiable factors (i.e. mediators) that could disrupt the impact of stigmas on HIV care and inform interventions.

背景：在全球范围内，污名化仍然是参与和留住艾滋病毒携带者的主要障碍。的 该提案的目的是了解多重污名对抗逆转录病毒（ART）的影响 男男性行为者（MSM）和跨性别者（TW）在开始和继续接受护理方面的情况 艾滋病毒感染者（MSM/TW+H）。印度是世界上第三大艾滋病毒负担国， 不成比例地影响MSM/TW。关键（污名化）人群，如MSM/TW+H， 艾滋病毒治疗结果不佳，导致ART启动/保留率和病毒感染率下降， 抑制率低得令人无法接受，无法实现艾滋病规划署90-90- 90目标。在印度，MSM和TW 妇女，虽然两个不同的人口，面临着类似的性别或性身份和艾滋病毒相关的 耻辱，这可能：（1）直接阻碍艾滋病毒护理的参与，（2）间接降低能力 通过心理健康状况不佳（抑郁/焦虑）等媒介参与艾滋病毒护理， 心理资源（如应对能力差）和人际因素（如缺乏社会 支持）。 需要研究污名化及其对艾滋病毒结果的中介途径。 方法：这项R21研究，响应PA 18-277，“与服务合作设计的研究 供应商...了解影响抗逆转录病毒治疗启动的因素保留，”是一个创新的 与印度最大的社区艾滋病服务机构建立合作社区研究伙伴关系 提供商它旨在利用该机构强大的服务和跟踪基础设施， 进行一项纵向前瞻性队列研究，研究污名、相关临床结局（ART） 启动和保留在6个月），和潜在的介质在370个MSM的T-TW +H（185 MSM/TW每个）。 在艾滋病毒污名框架的指导下，我们的目标是：1）描述艾滋病毒的流行和变化， 新诊断的印度MSM/TW+H队列中多重污名的时间。这还将涉及 探索MSM和TW之间的污名水平和类型的潜在差异，以告知未来 干预发展。2)检查纵向直接和间接（通过心理健康， 人际因素和心理资源）对污名的影响a）3 B）6个月时保留ART护理。我们还将探讨不同的幅度， 对每个结果的不同污名的影响，以更好地了解哪些是最强的 未来干预的目标。我们还将进行探索性分析，以a）检查 MSM与TW的这些影响差异;以及 B）确定今后的干预措施如何能够适应每个群体的需要。 潜在影响。虽然全球卫生机构呼吁减少艾滋病毒和MSM/TW的耻辱，但没有 存在有效和可扩展的干预措施，可解决男男性行为者/TW+H中的多重耻辱， 艾滋病毒护理连续成果。本研究将提供所需的经验数据的倍数 MSM/TW+H面临的污名，这些污名对ART启动/保持的影响，以及潜在的 可改变的因素（即媒介），可以破坏艾滋病毒护理的耻辱的影响，并告知 干预措施。