Co-occurring factors that heighten transgender women's vulnerability to suboptimal ART adherence in India

导致印度变性女性接受辅助生殖技术依从性不佳的同时发生的因素

• 批准号: 10686933
• 负责人: William Lodge
• 金额: $ 5.21万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10686933
• 关键词: AIDS prevention; Address; Adherence; Advocacy; Affect; Alcohol consumption; Anus; Award; Buffers; Caring; Cities; Clinic; Clinical; Clinical Services; Collaborations; Continuity of Patient Care; Data; Discrimination; Drug usage; Emotional; Environment; Face; Family; Funding; Future; Gender Identity; Goals; Grant; HIV; Health Professional; Healthcare; Healthcare Systems; India; Individual; Intervention; Interview; Location; Mental Depression; Mentors; Morbidity - disease rate; Outcome; Patient Self-Report; Pattern; Persons; Plasma; Poverty; Prevalence; Productivity; Publishing; Research; Risk; Risk Reduction; Role; Services; Sexual Partners; Sexual Transmission; Sexual and Gender Minorities; Site; Social Work; Social support; Testing; Transact; Transportation; Trust; United States National Institutes of Health; Vagina; Victimization; Viral; Viral Load result; Work; antiretroviral therapy; care outcomes; care systems; coping; cultural competence; design; effective intervention; experience; gender minority health; group intervention; high risk; high risk population; housing instability; improved; informant; men who have sex with men; mortality; multilevel analysis; outreach; peer; pilot test; preference; prevention service; programs; psychosocial; research study; resilience; service providers; sex; sexual risk behavior; skills; social stigma; structural determinants; substance use; substance use treatment; syndemic; therapy adherence; transgender; transgender women; transmission process; treatment program

SUMMARY Background: In India, HIV prevalence is highest among transgender women (TGW) or Hijras. Although HIV can be managed with ongoing antiretroviral therapy (ART), achieving maximal benefit necessitates engagement with the healthcare system and requires excellent adherence, which has shown to be challenging in India despite ART being free. Studies have shown that TGW in India experience high rates of individual (e.g., drug and alcohol use, depression), interpersonal (e.g., victimization, discrimination), and structural (e.g., poverty, housing instability, clinic access) challenges. While limited evidence suggests that these co-occurring syndemic factors are associated with suboptimal adherence and viral suppression among TGW in other settings, little is known about whether and how these factors influence ART adherence and viral suppression among TGW in India. Moreover, while TGW experience high rates of discrimination and familial rejection based on their gender identity, which may be compounded for TGW living with HIV, many TGW in India counteract this familial and societal rejection by forming their own family units comprised of other TGW. Based on research in other settings, this social support might buffer the detrimental effect syndemic factors may have on ART adherence. Environment: We will leverage an established, 16-year research collaboration between the PI’s mentors and Humsafar Trust (HST), the largest NGO focused on sexual and gender minority health in India – with research sites in both Mumbai and New Delhi, India's two biggest cities with 12.5 and 16.8 million people, respectively. Approach: The study aims to understand patterns and high-risk groups underlying suboptimal ART adherence and unsuppressed viral load related to substance use, stigma, and other syndemic factors among TGW in Mumbai and New Delhi, India and to assess potential buffering mechanisms for future intervention targets. To this end, we propose to: (1) conduct qualitative interviews with TGW (n=30) and clinical and social service providers (n=10) to assess the individual, interpersonal and structural level syndemic factors impacting ART adherence and unsuppressed viral load; and (2) to characterize patterns of multilevel syndemic factors and identify high-risk profiles of 150 TGW living with HIV in Mumbai and New Delhi. We will conduct a quantitative assessment and use Latent Class Analysis (LCA) to determine the patterns of the multilevel barriers that arise in Aim 1, and fit a multilevel model to better understand the relationships between the identified syndemic classes and unsuppressed viral load (via plasma viral load testing) and ART adherence (via self-report). Findings from this R36 doctoral dissertation award will provide preliminary data, using qualitative and LCA syndemic risk profiles, to support the submission of a larger NIH grant to design and pilot test an adaptive, multi-component (e.g., possibly including substance use treatment, resilience coping, skill-building) intervention to improve HIV care continuum outcomes among TGW living with HIV in India.

总结 背景：在印度，艾滋病毒感染率在变性妇女（TGW）或海吉拉中最高。虽然艾滋病毒可以 通过持续的抗逆转录病毒治疗（ART）进行管理，实现最大效益需要参与 医疗保健系统，并要求良好的坚持，这在印度已被证明是具有挑战性的，尽管 艺术是自由的。研究表明，印度的TGW经历了高比率的个人（例如，药物和酒精 使用，抑郁症），人际关系（例如，受害、歧视）和结构性（例如，贫困、住房 不稳定、诊所准入）挑战。虽然有限的证据表明，这些共同发生的症状因素， 与TGW在其他环境中的次优依从性和病毒抑制相关， 这些因素是否以及如何影响印度TGW的ART依从性和病毒抑制。 此外，虽然过渡妇女群体因性别而遭受歧视和家庭排斥的比例很高， 身份，这可能是复杂的TGW艾滋病毒感染者，许多TGW在印度抵制这种家庭， 社会排斥，形成自己的家庭单位组成的其他TGW。基于对其他环境的研究， 这种社会支持可能会缓冲流行病因素对ART依从性的不利影响。 环境：我们将利用PI导师之间建立的16年研究合作， Humsafar Trust（HST）是印度最大的非政府组织，专注于性和性别少数群体的健康-研究 在印度最大的两个城市孟买和新德里，分别有1250万和1680万人口， 分别方法：该研究旨在了解次优ART的模式和高危人群 坚持和未抑制的病毒载量有关的物质使用，耻辱和其他症状因素， 印度孟买和新德里的TGW，并评估未来干预的潜在缓冲机制 目标的为此，我们建议：（1）对TGW（n=30）和临床和社会进行定性访谈 服务提供者（n=10），以评估个人，人际和结构层面的综合因素影响 ART依从性和未抑制的病毒载量;和（2）表征多水平症状因素的模式， 查明孟买和新德里150名感染艾滋病毒的过渡期妇女的高危情况。我们将进行定量分析， 评估和使用潜在类别分析（LCA）来确定出现的多层次障碍的模式 在目标1中，并拟合一个多水平模型，以更好地理解所识别的发病类别之间的关系 和未抑制的病毒载量（通过血浆病毒载量测试）和ART依从性（通过自我报告）。的结果 这个R36博士论文奖将使用定性和LCA的疫情风险提供初步数据 配置文件，以支持提交一个更大的NIH赠款，设计和试点测试一个自适应，多组件 (e.g.,可能包括药物使用治疗、应对韧性、技能建设）干预，以改善艾滋病毒 在印度感染艾滋病毒的TGW之间的护理连续性成果。