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.

项目摘要 父母补助金：16-28岁处于发育期的艾滋病毒感染者，我们 被称为“青年和新兴成年人”（是的），在艾滋病毒护理方面的参与率最低。 连续体（HCC），最明显的非裔美国人/黑人和拉丁美洲人YEA-LWH。然而，我们的知识 促进或阻碍沿着HCC参与的因素不足。混合方法的前景 纵向研究的重点是非洲裔美国人/黑人和拉丁裔（AABL）YEA-LWH（16-28岁的艾滋病毒感染者） 在NYC和纽瓦克，NJ，N=270），有和没有病毒抑制，并使用定量，定性， 生物标志物（HIV病毒载量，药物使用）和生态瞬时评估方法，以揭示，描述， 更好地了解随着时间的推移，沿着HCC参与轨迹的因素， 准确性，包括从YEA-LWH的角度来看。建议补充：快速抗逆转录病毒疗法已成为标准 在过去的几年里，国际，国家和地方各级的艾滋病毒治疗政策。作为艾滋病毒临床 护理站点转向快速ART实施，重要的是要了解影响 在这一关键时刻的决策和行为沿着HCC。虽然文献主要探讨了 新诊断的成年艾滋病毒感染者的观点和经验，缺乏了解 已经脱离护理和/或决定重新参与护理并重新开始快速抗逆转录病毒治疗的人。 此外，美国艾滋病毒流行的特点是年轻人和 种族/民族、性别和性少数群体。至关重要的是要阐明障碍，促进者， 影响关于AABL性和/或性行为的ART重新启动的决策和行为的背景因素 性别少数群体（SGM）YEA-LWH。这些关键问题尚未在文献中探讨。这 混合方法补充提案将涉及R 01母研究数据的定量分析 检查诊断时快速开始ART（这不是母研究的一个方面）， 人口统计学和心理社会因素（物质使用、心理健康、艾滋病毒相关污名、交叉 耻辱，医疗不信任和歧视）和艾滋病毒护理参与。我们假设快速ART将 与艾滋病护理脱离有关。对于定性部分，我们将对30名参与者进行抽样 从母研究中招募，一半最近重新参与护理/重新开始ART，另一半脱离/未参与 艺术，参与深度访谈，Photovoice方法和焦点小组讨论，以探讨 上述心理社会因素，并引出和描述其他紧急的背景因素，由一个 基于社会行动理论的多层次方法。该补充的结果将有助于 为政策制定者和提供者提供以公平为重点的建议，以支持AABL SGM YEA-LWH在艾滋病毒方面的工作 重新参与护理和快速启动抗逆转录病毒治疗。