Identifying socioecological profiles that impact changes in care outcomes among Black Sexual minority men living with HIV

确定影响感染艾滋病毒的黑人性少数男性护理结果变化的社会生态特征

• 批准号: 10675256
• 负责人: Derek Tramel Dangerfield II
• 金额: $ 89.87万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-15 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675256
• 关键词: Accounting; Adherence; Adolescent; Baltimore; Black race; COVID-19; Caring; Chi-Square Tests; Cities; Cohort Studies; Collaborations; Continuity of Patient Care; Data; Drug usage; Drug user; Economics; Enrollment; Epidemiology; Equity; Generations; Goals; HIV; High Prevalence; Incidence; Knowledge; Life Cycle Stages; Literature; Locales; Longitudinal Studies; Maps; Measures; Medical; Mental Depression; Methods; Modeling; Outcome; Participant; Pattern; Phase; Philadelphia; Population; Prospective Studies; Prospective cohort; Prospective, cohort study; Psychometrics; Research; Research Personnel; Resources; Risk; Sampling; Service delivery model; Sexuality; Surveys; Target Populations; United States National Institutes of Health; Update; Victimization; Viral; Washington; Work; acceptability and feasibility; age group; age related; care outcomes; cohort; design; differences in access; digital; effectiveness testing; epidemic preparedness; experience; health care service organization; improved; improved outcome; longitudinal analysis; marginalized population; men; novel; prospective; racism; recruit; sexual minority men; social stigma; telehealth; theories; transgender women; treatment adherence; trend

Project Summary/Abstract The U.S. will not meet the targets of the Ending the HIV Epidemic Plan (EHE) without an intentional focus on improving outcomes among Black sexual minority men living with HIV (BSMM LWH). Only 55% of BSMM LWH maintain 100% daily treatment adherence and only 62% are virally suppressed. Research proves that multilevel factors such as racism, stigma, depression, victimization, and economic instability are important unaddressed determinants of HIV care outcomes. Updates to health care delivery models due to COVID-19 (i.e. telehealth) provided novel ways to improve HIV care engagement, retention, and adherence. However, BSMM still experience worse outcomes than others even when accounting for differences in access to resources. The literature collectively suggests that multilevel factors could create distinct socioecological patterns that impact HIV care outcomes for BSMM LWH, especially across age groups. BSMM LWH have not adequately engaged or retained in care activities because previous approaches do not account for their current or combined socioecological experiences. Previous studies are outdated, cross-sectional, utilize culturally inappropriate measures, and have small samples of Black participants. Sustainable approaches to engage this population remain elusive, especially for young BSMM LWH. There is no digital, limited interaction cohort study centered on BSMM LWH despite focus given to other priority populations such as transwomen, drug users, and adolescents. The goal of this Limited Interaction Targeted Epidemiology proposal is to conduct a prospective cohort study to identify the HIV care riskscape for BSMM LWH and examine how multilevel factors impact changes in retention in HIV care, treatment adherence, and viral suppression. Phase 1 will identify effective recruitment strategies (Aim 1) and validate commonly accepted scales among BSMM LWH to aid in survey design (Aim 2). Then we will explore the feasibility and acceptability of enrolling a large digital cohort of Mid-Atlantic BSMM LWH (Aim 3). Phase 2 will collect and analyze prospective cohort data collected at baseline, 3-months, 6-months to quantify the cross sectional and longitudinal relationships between multilevel factors and HIV care outcomes among 1,500 BSMM LWH (Aim 4). This study will be the largest prospective cohort focused on BSMM LWH ever conducted and targets high-priority EHE locales. This study aligns with NIH priorities to map longitudinal trajectories of the HIV care continuum, identify predictors of changes in viral suppression, and support large studies led by Black investigators. This work also builds upon the existing collaboration, resources, and support of the Mid Atlantic CFAR Consortium and is the next step needed in our work to design equitable approaches to improve HIV care outcomes for BSMM LWH.

项目总结/摘要 美国将无法实现终止艾滋病毒流行病计划（EHE）的目标，除非有一个明确的目标。 重点改善感染艾滋病毒的性少数黑人男性的结果（BSMM LWH）。只有55%的 BSMM LWH保持100%的每日治疗依从性，只有62%的患者被病毒抑制。研究证明 种族主义、耻辱、抑郁、受害和经济不稳定等多层面因素都很重要 艾滋病毒护理成果的决定因素。因COVID-19而更新的医疗保健提供模式 (i.e.远程医疗）提供了新的方法来改善艾滋病毒护理的参与，保留和坚持。然而，在这方面， BSMM仍然比其他人经历更差的结果，即使在考虑获得 资源这些文献共同表明，多层次的因素可以创造不同的社会生态 影响BSMM LWH的艾滋病毒护理结果的模式，特别是跨年龄组。BSMM LWH没有 充分参与或保留护理活动，因为以前的方法没有考虑到他们目前的 或社会生态学经验的结合。以前的研究是过时的，横截面的，利用文化 不适当的措施，并有黑人参与者的小样本。可持续的方法来参与 人口仍然难以捉摸，特别是年轻的BSMM LWH。没有数字化的、有限交互的队列研究 以BSMM LWH为中心，尽管重点是其他优先人群，如变性妇女，吸毒者， 和青少年。本有限相互作用靶向流行病学提案的目标是进行 前瞻性队列研究，以确定BSMM LWH的HIV护理风险，并检查多层次因素 影响艾滋病毒护理保留率、治疗依从性和病毒抑制的变化。第一阶段将确定 有效的招募策略（目标1），并验证BSMM LWH中普遍接受的量表，以帮助 调查设计（目标2）。然后，我们将探讨招募大型数字队列的可行性和可接受性。 中大西洋BSMM LWH（目标3）。第2阶段将收集并分析在以下时间点收集的前瞻性队列数据： 基线、3个月、6个月，以量化多水平之间的横截面和纵向关系 在1，500名BSMM LWH中调查了艾滋病毒因素和艾滋病毒护理结果（目标4）。这项研究将是最大的前瞻性 队列侧重于BSMM LWH进行过，目标是高优先级EHE地区。这项研究符合 美国国立卫生研究院优先绘制艾滋病毒护理连续体的纵向轨迹， 压制，并支持由黑人调查员领导的大型研究。这项工作还建立在现有的 中大西洋CFAR联盟的合作，资源和支持，是我们下一步需要的 努力设计公平的方法，以改善BSMM LWH的艾滋病毒护理成果。