Complementary & Alternative Care Behavior in HIV+ Latinos in the US-Mexico

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• 批准号: 7690659
• 负责人: Maria Luisa Zuniga de Nuncio
• 金额: $ 19.77万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7690659
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Ally; Behavior; Behavior Therapy; Caring; Characteristics; Communication; Communities; Complementary and alternative medicine; Development; Disclosure; Disease; Face; Future; Goals; HIV; HIV Seropositivity; Healed; Health; Health Insurance; Health Personnel; Health Services Accessibility; Health system; Healthcare; Improve Access; Intervention; Interview; Interviewer; Knowledge; Latino; Lead; Life; Medicine; Mexico; Modality; Nature; Outcome; Patients; Perception; Pharmacists; Pharmacy facility; Physicians; Phytotherapy; Population; Provider; Reaction; Religion and Spirituality; Reporting; Research; Sampling; Services; Side; Spirituality; Staging; Stigmata; Surveys; System; United States; Work; antiretroviral therapy; care delivery; care seeking; community based participatory research; effective intervention; experience; healing; health care service utilization; health disparity; improved; public health relevance; research study; response; satisfaction; social stigma; therapy adherence

DESCRIPTION (provided by applicant): The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos in the United States (US) - Mexico border region. HIV-positive Latinos in the US face substantial health disparities when compared to non- Latino Whites, including delayed care entry/entering care with advanced HIV disease and they are disproportionately impacted by HIV-stigma and poor patient-provider communication. CAM use (e.g. herbal therapies, alternative healers, and spirituality/religious practices) may be implicated in disparities (e.g. low antiretroviral therapy (ARVs) adherence). Study aims and hypotheses are: Aim 1: To assess CAM-specific health care behavior, including bi-national CAM utilization from allied/alternative health personnel (e.g. pharmacists, non-Western medicine healers) among HIV-positive Latinos residing in Tijuana and San Diego. Hypothesis 1 (H1) Greater use of CAM will be observed among HIV-positive Latinos who report a) crossing the U.S. border more frequently, and b) having migrated to Tijuana or San Diego (e.g. from southern Mexico). Aim 2: To assess use of CAM in the context of HIV treatment utilization and practices, including factors related to delayed entry into HIV care (e.g. HIV stigma); and utilization of and adherence to ARVs among HIV-positive Latinos residing in Tijuana or San Diego. H2.a) Compared to HIV-positive Latinos who report using herbal CAM, those who do not use herbal CAM are more likely to be receiving ARVs and report higher levels of adherence to ARVs; H2.b) Compared to HIV-positive Latinos who do not attend religious services regularly, those who attend religious services regularly are more likely to be receiving ARV; H2.c) Compared to HIV- positive Latinos who report experiencing HIV-related stigma, those who do not report experiencing HIV-related stigma are significantly more likely to be receiving ARV. Aim 3: To determine perceived barriers to communicating use of CAM and ARV adherence to clinicians among HIV-positive Latinos residing in Tijuana or San Diego, including satisfaction with clinician communication, concern about clinician response to reporting CAM use and perception of ARV efficacy; H3) Among CAM users, disclosure of CAM use will be higher among Latino patients who report higher satisfaction with clinician communication than among those who report lower satisfaction. Aim 4: To explore provider and system barriers to culturally-effective communication about CAM and ARV adherence in HIV+ Latinos. In Aims 1-3 we will conduct quantitative, interviewer-administered surveys with 200 HIV+ Latinos (100 from each side of the border). Aim 4 will assess clinician perspectives on CAM through interviews with 20 HIV clinicians on both sides of the border. This study will reduce health disparities in US Latinos by improving culturally-effective clinician communication and will lead to interventions to increase adherence to ARVs and improved health outcomes. PUBLIC HEALTH RELEVANCE: The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos on the San Diego/Tijuana border. CAM use among US Latinos living with HIV is associated with delayed utilization of and poor adherence to antiretroviral therapies (ARVs) that may exacerbate health disparities in HIV care access and health outcomes. This study will lead to development of culturally-effective interventions to improve access and adherence to HIV care in Latinos who face health disparities.

描述（由申请人提供）：我们基于社区的参与性研究的目标是确定美国 (US) - 墨西哥边境地区艾滋病毒呈阳性的拉丁美洲人使用补充和替代医学 (CAM) 的性质和程度。与非拉丁裔白人相比，美国艾滋病毒呈阳性的拉丁裔面临着巨大的健康差异，包括延迟进入护理/进入晚期艾滋病毒护理，并且他们受到艾滋病毒耻辱和患者与提供者沟通不畅的影响尤为严重。 CAM 的使用（例如草药疗法、替代疗法和灵性/宗教实践）可能会造成差异（例如抗逆转录病毒疗法 (ARV) 依从性低）。研究目的和假设是： 目标 1：评估 CAM 特定的医疗保健行为，包括居住在蒂华纳和圣​​地亚哥的 HIV 阳性拉丁美洲人中联合/替代卫生人员（例如药剂师、非西医治疗师）的跨国 CAM 使用情况。假设 1 (H1) 在 HIV 阳性拉丁裔中观察到更多地使用 CAM，他们报告 a) 更频繁地跨越美​​国边境，b) 迁移到蒂华纳或圣地亚哥（例如从墨西哥南部）。目标 2：评估 CAM 在 HIV 治疗利用和实践中的使用，包括与延迟进入 HIV 护理相关的因素（例如 HIV 耻辱）；居住在蒂华纳或圣地亚哥的艾滋病毒呈阳性的拉丁美洲人对抗逆转录病毒药物的使用和依从性。 H2.a) 与报告使用草药 CAM 的 HIV 阳性拉丁裔相比，那些不使用草药 CAM 的人更有可能接受 ARV 治疗，并且报告对 ARV 的依从性更高； H2.b) 与不定期参加宗教仪式的艾滋病毒阳性拉丁裔相比，定期参加宗教仪式的人更有可能接受抗逆转录病毒治疗； H2.c) 与报告经历与艾滋病毒相关的耻辱的艾滋病毒阳性拉丁裔相比，那些没有报告经历与艾滋病毒相关的耻辱的人更有可能接受抗逆转录病毒治疗。目标 3：确定居住在蒂华纳或圣地亚哥的 HIV 阳性拉丁美洲人中与临床医生沟通 CAM 和 ARV 依从性的障碍，包括对临床医生沟通的满意度、对临床医生对报告 CAM 使用情况反应的担忧以及对 ARV 疗效的看法； H3) 在 CAM 用户中，对临床医生沟通满意度较高的拉丁裔患者比满意度较低的拉丁裔患者披露 CAM 使用情况的比例更高。目标 4：探索艾滋病毒+拉丁裔人群在关于 CAM 和 ARV 依从性的文化上有效沟通的提供者和系统障碍。在目标 1-3 中，我们将对 200 名 HIV+ 拉丁裔（边境两侧各 100 名）进行由访谈员管理的定量调查。目标 4 将通过采访边境两侧的 20 名 HIV 临床医生来评估临床医生对 CAM 的看法。这项研究将通过改善文化上有效的临床医生沟通来减少美国拉丁裔的健康差异，并将导致采取干预措施，以提高抗逆转录病毒药物的依从性并改善健康结果。公共卫生相关性：我们基于社区的参与性研究的目标是确定圣地亚哥/蒂华纳边境艾滋病毒阳性拉丁裔人群使用补充和替代医学 (CAM) 的性质和程度。美国拉丁裔艾滋病毒感染者使用 CAM 与抗逆转录病毒疗法 (ARV) 的延迟使用和依从性差有关，这可能会加剧艾滋病毒护理获取和健康结果方面的健康差距。这项研究将导致制定文化上有效的干预措施，以改善面临健康差距的拉丁美洲人获得艾滋病毒护理的机会和依从性。