Polysubstance use and mental health outcomes after substance abuse treatment among community-based men of color who have sex with men in Los Angeles living with and without HIV

项目摘要 本论文旨在更好地了解物质使用，治疗和心理健康 结果发生在居住在加利福尼亚州洛杉矶的有色人种男性与男性发生性关系（MoCSM）之后 退出正式的物质滥用治疗（SAT）计划，如果这些结果因人而异， 艾滋病病毒感染者（PWH）与非艾滋病病毒感染者（PWOH）之间的差异。研究的目的是 确定哪些社会和结构因素阻碍或促进积极的SAT参与， 物质使用减少，抑郁和焦虑的结果，以促进更高的质量 在康复中的生命。这些目标将使用来自NIDA资助的mSTUDY的数据来实现 (U01 DA 036267）在洛杉矶超过500例MoCSM的前瞻性队列中， 目标1：采用纵向 来自MoCSM队列（2014-2023）的数据描述了参与，退出和重新进入SAT。 评估社会人口因素、基线药物使用和艾滋病毒状况之间的关联 基线和随访期间的SAT。目标2：评估自我报告频率的变化 mSTUDY参与者中的甲基苯丙胺、可卡因、大麻、烟草和酒精使用 在治疗后3年内退出药物滥用治疗的患者。在人们使用 甲基苯丙胺，可卡因，大麻，烟草或酒精在基线时，评估是否有先前的人 SAT使用这些物质的频率低于从未接受过治疗的人， 以及使用结果是否因艾滋病毒状况而异。目标3：评估抑郁症或抑郁症之间的差异 焦虑症状（分别用CES-D 13和GAD-7 14测量） 有和没有SAT的人。评估这些关联是否因HIV状态而异。之间 在恢复中的人，评估是否更高的社会支持分数（由MSPSS 15测量） 与改善抑郁和焦虑的结果有关。结果将在 在基线时有既往SAT的129名男性中进行了4，319次研究访视，91名男性首次进入 SAT在随访期间，和358人谁使用的物质，但从未接受过治疗。 将进行描述性统计和数据可视化，并将这些结果 通过多项式回归、逻辑回归和广义估计进行评估 方程，适当时，调整相关的混杂因素。通过评估 研究不足，长期的心理健康，治疗和药物滥用因素， 药物滥用治疗，并分析这些结果的差异，由于结构 因素，本论文将有助于了解是什么支持更好的复苏结果， 洛杉矶的社区MoCSM感染和未感染艾滋病毒。

Project Abstract This dissertation aims to better understand what substance use, treatment, and mental health outcomes occur after men of color who have sex with men (MoCSM) who live in Los Angeles, CA exit formal substance abuse treatment (SAT) programs, and if these outcomes vary across people living with HIV (PWH) versus people living without HIV (PWOH). The objective of the research is to identify which social and structural factors impede or foster positive SAT engagement, substance use reduction, depression, and anxiety outcomes in order to promote a higher quality of life for MoCSM in recovery. These goals will be met using data from the NIDA-funded mSTUDY (U01 DA036267) prospective cohort of over 500 MoCSM in Los Angeles, approximately half of whom are PWH, and will be accomplished through the following aims: Aim 1: Using longitudinal data from a cohort of MoCSM (2014-2023), describe engagement in, exits, and re-entry into SAT. Assess how sociodemographic factors, baseline substance use, and HIV status are associated with SAT at baseline and during follow up. Aim 2: Evaluate changes in self-reported frequency of methamphetamine, cocaine, cannabis, tobacco, and alcohol use among mSTUDY participants who have exited substance abuse treatment up to 3 years post-treatment. Among people use methamphetamine, cocaine, cannabis, tobacco, or alcohol at baseline, assess if people with prior SAT use those substances at a lower frequency than people who have never been in treatment, and if use outcomes vary by HIV status. Aim 3: Assess if there are differences in depression or anxiety symptoms (respectively measured by CES-D 13 and GAD-7 14) following SAT among people with and without prior SAT. Evaluate if these associations vary by HIV status. Among people in recovery, assess if higher social support scores (measured by MSPSS 15) are associated with improved depression and anxiety outcomes. Outcomes will be assessed across 4,319 study visits conducted across 129 men with prior SAT at baseline, 91 men who first entered SAT during follow-up, and 358 men who use substances but have never received treatment. Descriptive statistics and data visualization will be performed, and these outcomes will be assessed through multinomial regression, logistic regression, and generalized estimating equations, as appropriate, adjusting for relevant confounding factors. Through assessing the understudied, longer-term mental health, treatment, and substance abuse factors following substance abuse treatment, and analyzing the differences in these outcomes due to structural factors, this dissertation will help understand what supports better recovery outcomes among community-based MoCSM living with and without HIV in Los Angeles.