Effects of trauma on retention in HIV care and durable viral suppression among African American men and women

项目摘要 艾滋病毒感染者（PWH）在他们的生活中经历人际创伤的可能性要高出两到五倍。 寿命比一般人群1 -3.人际创伤（儿童期身体虐待、儿童期性虐待 [复杂创伤]，成人身体和性侵犯，以及亲密伴侣暴力[IPV/成人伴侣虐待]） 对治疗依从性、继续护理、病毒抑制4 -9和HIV传播产生负面影响4，39 非裔美国人（A.A.）承担着不成比例的艾滋病毒和创伤负担2，10- 12，39 -40。艾滋病毒传播率 男性和女性艾滋病毒感染者的健康结果不同，这种差异可能与他们的 创伤经历13 -15.创伤对匿名戒酒会的影响。男性和女性继续接受艾滋病毒护理，即， 保持常规的医疗预约和持久的病毒抑制，还没有得到很好的理解。长- 在艾滋病毒护理中保留长期护理对于预防艾滋病毒疾病进展、提高治疗依从性和 抑制病毒载量，增加积极的临床健康结果，减少艾滋病毒传播， 死亡率4.以前的研究表明，长期保留在艾滋病毒护理之间的AA。艾滋病毒感染者 在艾滋病毒护理开始后36个月时，46%的人感染了艾滋病毒，而非黑人参与者为63%。结果还 显示出在A.A.之间持久的病毒抑制方面的种族差异。男性和女性艾滋病毒感染者4，16开始在12 艾滋病毒护理开始后的几个月及以后，增加了艾滋病毒传播的潜在风险24，33。A.A. 占美国近120万PWH的40%（479，300），在近36，801例新的艾滋病毒诊断中， 在美国，while only representing代表13% of the U.S. population人口39 -40. A.A.女性的临床表现最差 健康结果11，12和更多的创伤经历比所有种族和民族10- 12，17。hiv阳性男性 比感染艾滋病毒的妇女遭受创伤的比率低;然而，她们遭受的创伤比感染艾滋病毒的妇女更多， 消极的人2.到目前为止，大多数研究都使用了横断面设计来检查 保留在艾滋病毒护理，病毒抑制4，和创伤的经验，提供了一个单一的快照 时刻12，18.为了更深入地了解长期的临床研究，需要进行纵向研究。 创伤在艾滋病护理中的保留和A.A.中持久的病毒抑制的影响。PWH。的 这个F31奖学金的目的，题为镜子（创伤和艾滋病毒：艾滋病毒护理和病毒 负载抑制挽救生命），是进行二次分析，测试 每种类型的人际创伤和经历过创伤的生命阶段（童年，成年）对保留的影响 在艾滋病护理和持久的病毒抑制中，感染艾滋病毒超过24个月的男性和女性的 拟议的研究将利用R 01 MH 092286“健康素养对健康差异的影响， HIV临床结局”（P.I.：Waldrop），一项在700名男性和女性中完成的纵向研究 （n=424名黑人/非裔美国人）;并使用母项目的辅助研究“检查 护理和健康素养”（ENRICH）（F31-NR 017580：PI。A.安德森）。

PROJECT SUMMARY People with HIV (PWH) are two to five times more likely to have experienced interpersonal trauma in their lifetime than the general population1-3. Interpersonal trauma (childhood physical abuse, childhood sexual abuse [complex trauma], adult physical and sexual assault, and intimate partner violence [IPV/Adult Partner Abuse]) negatively impacts treatment adherence, retention in care, and viral suppression4-9 and HIV transmission4,39 African Americans (A.A.) bear a disproportionate burden of HIV and trauma2,10-12,39-40. HIV transmission rates and health outcomes differ for men and women with HIV, a difference that may be associated with their experience of trauma13-15. The impact of trauma for A.A. men and women on retention in HIV care, that is, keeping routine medical appointments and durable viral suppression, is not well understood. Long- term retention in HIV care is critical in preventing HIV disease progression, improving treatment adherence and viral load suppression, increasing positive clinical health outcomes and reducing HIV transmission and mortality4. Previous research showed that long-term retention in HIV care among A.A. living with HIV was only 46% at 36 months since the start of HIV care compared to 63% in the nonblack participants4. Results also showed racial disparities in durable viral suppression among A.A. men and women with HIV 4,16 begin at 12 months since the start of HIV care and beyond, increasing the potential risk of HIV transmission 24,33. A.A. account for 40% (479,300) of nearly 1.2 million PWH in the U.S., and 42% of nearly 36,801 new HIV diagnoses in the U.S., while only representing 13% of the U.S. population39-40. A.A. women have the poorest clinical health outcomes11,12 and greater experience of trauma than all races and ethnicities 10-12,17. HIV-positive men experience lower rates of trauma than women with HIV; however, they experience more trauma than HIV- negative men2. Thus far, most studies have used a cross-sectional design to examine relationships between retention in HIV care, viral suppression4, and trauma experiences providing only a snapshot of a single moment in time 12,18. Longitudinal studies are needed for a deeper understanding of the long-term clinical implications of trauma in retention in HIV care and durable viral suppression among the A.A. PWH. The purpose of this F31 fellowship, entitled MIRRORS (TRAUMA & HIV: RETENTION in HIV CARE and VIRAL LOAD SUPPRESSION SAVES LIVES), is to conduct a secondary analysis testing the relative contribution of each type of interpersonal trauma and life stages with experienced trauma (childhood, adulthood) on retention in HIV care and durable viral suppression among A.A. men and women with HIV over 24 months. The proposed study will utilize datasets from R01 MH092286 “Effects of Health Literacy on Health Disparities in HIV Clinical Outcomes” (P.I.: Waldrop), a completed longitudinal study among 700 men and women (n=424 Black/African American) with HIV; and use the parent project’s ancillary study, “Examining Retention in Care and Health Literacy” (ENRICH) (F31- NR017580: PI. A. Anderson).