Rapid ART and HIV Care Engagement Among Young Black and Latinx Sexual and Gender Minorities with HIV: A Mixed Methods Study

感染艾滋病毒的年轻黑人和拉丁裔性少数群体的快速抗逆转录病毒疗法和艾滋病毒护理参与：一项混合方法研究

• 批准号: 10797771
• 负责人: Marya Gwadz
• 金额: $ 20.8万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10797771
• 关键词: Address; Adult; African American; Age; Appointment; Behavior; Biological Markers; Black race; Caring; Characteristics; Cities; Cohort Studies; Consensus; Continuity of Patient Care; Data; Decision Making; Demographic Factors; Development; Diagnosis; Discrimination; Disparity; Drug usage; Ecological momentary assessment; Eligibility Determination; Enrollment; Epidemic; Equity; Evaluation; Focus Groups; Fostering; Funding; Future; HIV; HIV diagnosis; Housing; Individual; Information Dissemination; Insurance; International; Intervention; Interview; Knowledge; Latinx; Literature; Measures; Mediating; Medical; Mental Health; Methodology; Methods; National Institute of Drug Abuse; New York City; Newly Diagnosed; Outcome; Parents; Participant; Patient Recruitments; Patients; Pattern; Perception; Persons; Policies; Policy Maker; Population; Prevalence; Process; Protocols documentation; Provider; Psychosocial Factor; Reporting; Role; Sampling; Sexual and Gender Minorities; Site; Surveys; Time; Viral; Viral Load result; Visit; Work; Youth; age group; age related; antiretroviral therapy; barrier to care; behavioral and social science; clinical care; contextual factors; design; distrust; drug use screening; emerging adult; empowerment; ethnic minority; experience; gender minority; gender minority youth; improved; longitudinal, prospective study; minority disparity; parent grant; policy recommendation; programs; racial minority; recruit; sexual minority; social; social stigma; substance use; systemic barrier; theories; tool

PROJECT SUMMARY Parent Grant: Young people living with HIV (LWH) in the developmental periods ages 16-28 years, which we refer to as “youth and emerging adults” (YEA), have the lowest rates of engagement along the HIV care continuum (HCC), most pronounced for African American/Black and Latinx YEA-LWH. Yet, our knowledge of factors that promote or impede engagement along the HCC is insufficient. The mixed methods prospective longitudinal study focuses on African American/Black and Latinx (AABL) YEA-LWH (ages 16-28 years with HIV in NYC and Newark, NJ, N=270) both with and without viral suppression and uses quantitative, qualitative, biomarker (HIV viral load, drug use), and ecological momentary assessment approaches to uncover, describe, and better understand factors contributing to trajectories of engagement along the HCC over time, with precision, including from YEA-LWH’s perspectives. Proposed Supplement: Rapid ART has become standard policy in HIV treatment on the international, national, and local levels over the last few years. As HIV clinical care sites move to rapid ART implementation, it is important to understand the contextual factors that influence decision making and behavior at this critical juncture along the HCC. While the literature mainly explores the perspectives and experiences of people newly diagnosed adults with HIV, there is a dearth of understanding around YEA-LWH who have been out of care and/or decide to re-engage in care and reinitiate rapid ART. In addition, the U.S. HIV epidemic is characterized by persistent disparities for younger people as well as racial/ethnic, gender, and sexual minorities. It is vital to illuminate the barriers, facilitators, and important contextual factors that influence decisions and behaviors regarding ART re-initiation for AABL sexual and/or gender minority (SGM) YEA-LWH. These critical questions have not yet been explored in the literature. This mixed methods supplement proposal will involve a quantitative analysis of the R01 parent study data examining associations between rapid ART initiation at diagnosis (which is not an aspect of the parent study), demographic and psychosocial factors (substance use, mental health, HIV-related stigma, intersectional stigma, medical distrust, and discrimination), and HIV care engagement. We hypothesize that rapid ART will be associated with HIV care disengagement. For the qualitative portion, we will sample a group of 30 participants recruited from the parent study, half recently re-engaged in care/re-initiating ART and half disengaged/not on ART, to participate in in-depth interviews, Photovoice methodology and focus group discussions to explore the aforementioned psychosocial factors and elicit and describe other emergent contextual factors, driven by a multi-level approach grounded in social action theory. The results from this supplement will contribute to equity-focused recommendations for policy-makers and providers to support AABL SGM YEA-LWH in HIV care re-engagement and rapid ART initiation.

项目总结 Parent Grant：16-28岁发育期的艾滋病毒携带者(LWH)年轻人，我们 被称为“青年和新兴成年人”(YEA)，在艾滋病毒护理方面参与率最低 连续体(HCC)，最明显的是非裔美国人/黑人和拉丁裔YEA-LWH。然而，我们所知道的 促进或阻碍肝细胞癌沿线参与的因素不足。混合方法的发展前景 纵向研究重点是非洲裔美国人/黑人和拉丁裔(AABL)YEA-LWH(16-28岁艾滋病毒携带者 在纽约和新泽西州纽瓦克，N=270)都有和没有病毒抑制，并使用定量、定性、 生物标记物(艾滋病毒病毒载量、药物使用)和生态瞬时评估方法，以发现、描述、 并更好地了解随着时间的推移影响肝细胞癌接触轨迹的因素， 精确度，包括从YEA-LWH的角度。建议补充：快速艺术已成为标准 过去几年在国际、国家和地方各级的艾滋病毒治疗政策。作为HIV临床 护理站点转向快速实施ART，重要的是要了解影响其实施的背景因素 在肝细胞癌的关键时刻的决策和行为。虽然文献主要探讨的是 新诊断的成人艾滋病毒感染者的观点和经历，缺乏了解 大约是那些已经脱离护理和/或决定重新从事护理和重新启动快速抗逆转录病毒治疗的YA-LWH。在……里面 此外，美国艾滋病毒流行的特点是年轻人以及 种族/民族、性别和性少数群体。阐明障碍、促进者和重要性至关重要 影响AABL性和/或ART重新启动的决定和行为的上下文因素 性别少数民族(SGM)是-LWH。这些关键问题在文献中还没有被探讨过。这 混合方法补充建议将涉及对R01家长研究数据的量化分析 检查诊断时快速启动抗逆转录病毒治疗(这不是父母研究的一个方面)之间的关联， 人口和心理社会因素(药物使用、心理健康、艾滋病毒相关耻辱、跨部门 耻辱、医疗不信任和歧视)和艾滋病毒护理参与度。我们假设快速艺术将是 与艾滋病毒护理脱离有关。对于定性部分，我们将从30名参与者中抽取样本 从家长研究招募，一半最近重新从事护理/重新发起ART，一半脱离/不参与 参加深度访谈、PhotoVoice方法论和焦点小组讨论，探索 上述心理社会因素，并引出和描述其他紧急背景因素，由 以社会行动理论为基础的多层次方法。本附录的结果将有助于 为政策制定者和提供者提供以股权为重点的建议，以支持AABL SGM YEA-LWH在艾滋病毒方面的应用 关爱重新投入和快速的艺术启蒙。