Limited interaction cohort to identify determinants of viral suppression in MSM and transfeminine individuals living with HIV: A multilevel approach

有限的相互作用队列来确定 MSM 和跨性别女性 HIV 感染者病毒抑制的决定因素：多层次方法

• 批准号: 10685845
• 负责人: Aaron Julius Siegler
• 金额: $ 251.09万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-04 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10685845
• 关键词: Attention; Behavior; Black Populations; Black race; Blood specimen; Caring; Characteristics; Cities; Collaborations; Communities; Data; Decision Making; Detection; Development; Discrimination; Enrollment; Environment; Epidemic; Epidemiologic Methods; Frequencies; Geography; HIV; HIV Infections; Health; Health Personnel; Hispanic; Individual; Intervention; Interview; Measures; Medical; Methods; Modeling; Monitor; Neighborhoods; Observational epidemiology; Participant; Pattern; Persons; Policies; Recommendation; Research; Risk; Risk Reduction; Sampling; Sex Behavior; Sexual Partners; Sexual and Gender Minorities; Shapes; Structural Racism; Subgroup; Testing; Time; Viral; Viral Load result; acceptability and feasibility; aged; black men who have sex with men; care seeking; cohort; community-level factor; effective intervention; experience; gender minority group; health care settings; men who have sex with men; multilevel analysis; outcome disparities; prevent; programs; racial disparity; recruit; remote grading; remote monitoring; research study; resilience; sample collection; social; social stigma; socioeconomics; substance use; therapy design; transfeminine; transgender; transmission process; virtual; young men who have sex with men

Abstract For people living with HIV (PLWH), achieving and maintaining viral suppression has critical benefits for their health and for reducing the risk of transmitting HIV to others. Viral suppression is thus a critical cornerstone of the US program to end HIV. However, over a third of people in the US living with HIV do not have a suppressed viral load. Some groups, including younger people and Black people, have lower levels of viral suppression. Although transfeminine people (TFP) have shown rates of viral suppression comparable to other groups, there is ample evidence that they experience a multitude of barriers to sustaining viral suppression, including multiple forms of stigma and structural barriers to accessing culturally appropriate care. In addition, there are wide racial disparities in HIV care among transgender communities, with Black TFP experiencing some of the lowest levels of viral suppression. A deep understanding if required of the circumstances that surround gaining, sustaining or losing viral suppression. Most research to date has focused on individual factors associated with viral suppression status. This approach is limited in that it restricts the consideration of the causes of lack of viral suppression to individual characteristics or behaviors, and misses the broader contexts – stigma, discrimination, lack of health coverage, distance to healthcare providers, and structural racism – that shape the risk of PLWH for losing viral suppression. Further, understanding these multilevel predicators of loss of viral suppression is required to develop interventions that are responsive to the circumstances that shape risks for remaining or becoming unsuppressed. Thus, we propose to enroll and follow a cohort of PLWH – both MSM and TFP – to observe the patterns of gaining, sustaining or losing viral suppression, and to develop information that can be used to inform the development of new interventions to support ongoing engagement in HIV care and viral suppression. Drawing on over a decade of experience in recruiting and retaining sexual and gender minority people in limited- interaction research studies, we will develop nuanced data about the unique factors that shape viral suppression or lack thereof in different critical groups, including Black MSM and TFP, and younger MSM, that are inequitably impacted by lack of viral suppression.

抽象的 对于患有艾滋病毒（PLWH）的人们，实现和维持病毒抑制对他们的 健康和降低将艾滋病毒传播给他人的风险。因此，病毒抑制是一个关键的基石 美国结束艾滋病毒的计划。但是，在美国，有三分之一的人患有艾滋病毒的人没有 抑制病毒负荷。一些小组，包括年轻人和黑人，病毒率较低 抑制。尽管经狂者（TFP）显示出与其他的病毒抑制率 小组，有足够的证据表明他们经历了维持病毒抑制的许多障碍， 包括多种形式的污名和结构性障碍，以获得适当的文化护理。此外， 在跨性别社区中，艾滋病毒护理中有广泛的种族分布，黑色TFP经历 一些病毒抑制的水平最低。 如果需要，请深入了解周围的情况，维持或失去病毒 抑制。迄今为止，大多数研究都集中在与病毒抑制状况相关的个人因素上。 这种方法是有限的，因为它限制了对缺乏病毒抑制的原因的考虑 个人特征或行为，错过了更广泛的环境 - 污名，歧视，缺乏健康 覆盖范围，距离医疗保健提供者的距离以及结构性种族主义 - 塑造了失去病毒的PLWH风险 抑制。此外，需要了解这些多层次预测病毒抑制的预测指标 制定对构成剩余或变为风险的情况有反应的干预措施 不受限制。 这，我们建议注册并遵循一系列PLWH（MSM和TFP），以观察 获得，维持或失去病毒抑制，并开发可用于告知该信息的信息 开发新的干预措施，以支持持续参与艾滋病毒护理和病毒抑制。绘画 有十多年的招募和保留性和性别少数族裔的经验 相互作用研究，我们将开发有关塑造病毒的独特因素的细微数据 在不同的关键群体中，包括黑色MSM和TFP以及年轻的MSM的抑制或缺乏抑制作用或缺乏抑制作用 由于缺乏病毒抑制而受到不平等影响。