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

摘要 对于艾滋病毒感染者（PLWH）来说，实现和维持病毒抑制对其至关重要 健康和减少艾滋病毒传播给他人的风险。因此，病毒抑制是 美国终结艾滋病计划然而，在美国，超过三分之一的艾滋病毒感染者没有一个 抑制病毒载量。一些群体，包括年轻人和黑人， 镇压尽管跨女性人群（TFP）的病毒抑制率与其他人群相当， 有充分的证据表明，他们在维持病毒抑制方面遇到了许多障碍， 包括多种形式的耻辱和获得文化上适当的护理的结构性障碍。此外，本发明还提供了一种方法， 在跨性别社区中，艾滋病毒护理存在着广泛的种族差异，黑人TFP经历着 最低水平的病毒抑制。 如果需要，深入了解获得、维持或失去病毒的情况 镇压迄今为止，大多数研究都集中在与病毒抑制状态相关的个体因素上。 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，而忽略了更广泛的背景-耻辱，歧视，缺乏健康 覆盖范围，与医疗保健提供者的距离和结构性种族主义-这些因素决定了PLWH失去病毒的风险 镇压此外，需要了解这些病毒抑制丧失的多水平预测因子， 制定干预措施，以应对影响留下来或成为 不受压制 因此，我们建议招募并随访一组PLWH（包括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 制定新的干预措施，以支持持续参与艾滋病毒护理和病毒抑制。绘图 在招聘和留住性和性别少数群体的十多年经验，在有限的- 互动研究，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，包括黑人MSM和TFP，以及年轻的MSM， 由于缺乏病毒抑制而受到不公平的影响。

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.