Neighborhoods, Networks, and the HIV Care Continuum among HIV-infected MSM in NYC

纽约市感染 HIV 的 MSM 的社区、网络和 HIV 护理连续体

• 批准号: 10534034
• 负责人: Hong Van Nhu Tieu
• 金额: $ 21.29万
• 依托单位: NEW YORK BLOOD CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10534034
• 关键词: Americas; Anti-Retroviral Agents; Black race; COVID-19; COVID-19 pandemic; COVID-19 pandemic effects; COVID-19 testing; COVID-19 treatment; Caring; Continuity of Patient Care; Data; Enrollment; Epidemic; Funding; HIV; Health; Healthcare; Interview; Longitudinal Studies; Medical; Methods; Minority Groups; Morbidity - disease rate; National Institute of Mental Health; Neighborhoods; New York City; Outcome; Participant; Patients; Population; Provider; Research; Sampling; United States Dept. of Health and Human Services; Viral; Viral Load result; Work; base; black men who have sex with men; cohort; experience; follow-up; improved; medical appointment; medication compliance; men; men who have sex with men; mortality; pandemic disease; psychosocial; racism; social stigma; therapy adherence

Abstract Rapid HIV treatment and sustained viral suppression is one of the 4 strategies in the U.S. Department of Health and Human Services (HHS) plan to end the HIV epidemic in America. HIV disparities among Black men who have sex with men (BMSM) have been documented along all stages of the HIV care continuum, with BMSM having higher morbidity and mortality rate, less likely to engaged in HIV care and achieve viral suppression. While many factors influence engagement in HIV care, it is particularly important to understand psychosocial deterrents such as stigma and medical mistrust among BMSM, as this population often experience overlapping stigmas. Intersectional stigma, medical mistrust, and decreased likelihood of referral for HIV or COVID-19 testing and treatment have been shown to be associated with reduced engagement in care among minority populations and individuals living with HIV. Patient-provider relationship has been shown to negatively influence engagement in HIV care; however, this association is not well document among BMSM who are living with HIV especially in the context of a pandemic. The specific aims of the proposed research in this 1-year Diversity Supplement are to: Aim 1. Using the baseline and follow-up data from the CASI, determine the association between patient- provider interaction and perceived racism in healthcare and engagement in HIV care (medical appointment attendance, antiretroviral medical therapy adherence, and viral suppression) among BMSM; and examine the effect of the COVID-19 pandemic on BMSM’s ability to navigate the HIV care continuum. Aim 2. Conduct a qualitative sub-study involving in-depth interviews among 50 NNHIV participants who self-identify as Black using stratified random sampling based on viral load suppression to: (a) Characterize experiences of provider interaction and perceived racism in healthcare among BMSM; (b) Examine the ways in which patient-provider relationship influences navigation of the HIV care continuum, and how it has been impacted by the COVID-19 pandemic; (c) Characterize intersectional stigma associated with COVID-19 and HIV and how it impacts navigation of the HIV care continuum and overall health outcomes among Black MSM; (d) Identify strategies that participants believe should be implemented to improve patient- provider interaction, reduce racism in health care and help BMSM navigate the HIV care continuum. This work is a sub-study of the ongoing NIMH R01-funded longitudinal study called Neighborhoods, Networks and HIV Care (NNHIV) among BMSM living with HIV who reside in New York City. The findings of this study will help us elucidate the NNHIV quantitative data and advance our understanding of the ways in which the COVID-19 pandemic, patient-provider interaction and HIV and COVID-19 stigmas influence engagement in care and viral suppression among BMSM.

摘要 快速艾滋病毒治疗和持续的病毒抑制是美国卫生部的4项战略之一。 卫生与公众服务部（HHS）计划结束美国的艾滋病流行。黑人男子艾滋病毒感染率差距 沿着艾滋病毒护理的各个阶段都有记录， BMSM的发病率和死亡率较高，不太可能从事艾滋病护理和实现病毒感染 镇压虽然许多因素影响艾滋病毒护理的参与，但特别重要的是要了解 社会心理障碍，如BMSM之间的耻辱和医疗不信任，因为这一人群往往 经历重叠的耻辱。交叉污名，医疗不信任和转诊可能性降低 艾滋病毒或COVID-19检测和治疗已被证明与减少参与有关 在少数群体和艾滋病毒感染者中提供护理。患者与供应商的关系已显示 对艾滋病毒护理的参与产生负面影响;然而，这种关联在BMSM中没有很好的记录， 特别是在流行病的情况下。拟议研究的具体目标是： 这个为期一年的多元化补充是：目标1。使用CASI的基线和随访数据， 确定患者-提供者互动与医疗保健中的种族主义之间的关联， 参与艾滋病毒护理（医疗预约出勤率，抗逆转录病毒药物治疗依从性，以及病毒 抑制）;并研究COVID-19大流行对BMSM导航能力的影响 艾滋病毒护理连续体。目标二。进行一项定性的次级研究，包括对50名 使用基于病毒载量抑制的分层随机抽样，自认为是黑人的NNHIV受试者 目的：（a）描述BMSM在医疗保健中的提供者互动和感知种族主义的经历;（B） 检查患者-提供者关系影响艾滋病毒护理连续体导航的方式， 它如何受到COVID-19大流行的影响;（c）描述与以下方面相关的交叉污名 COVID-19和艾滋病毒及其如何影响艾滋病毒护理连续体的导航和整体健康结果 （d）确定参与者认为应该实施的战略，以改善患者的健康状况。 提供者互动，减少卫生保健中的种族主义，并帮助BMSM浏览艾滋病毒护理连续体。这项工作 是正在进行的NIMH R 01资助的纵向研究的子研究，称为邻里，网络和艾滋病毒 护理（NNHIV）在居住在纽约市的BMSM艾滋病毒感染者中。这项研究的发现将帮助我们 阐明NNHIV定量数据，并推进我们对COVID-19 大流行、患者与提供者的互动以及艾滋病毒和COVID-19的污名影响了护理和病毒感染的参与 BMSM之间的抑制。