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

描述(申请人提供)：我们以社区为基础的参与性研究的目标是确定在美国-墨西哥边境地区艾滋病毒阳性的拉丁裔中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，美国艾滋病毒阳性的拉丁裔面临着巨大的健康差距，包括延迟进入/进入患有晚期艾滋病毒疾病的护理，他们受到艾滋病毒污名和患者与提供者沟通不良的不成比例的影响。CAM的使用(例如，草药疗法、替代疗法和灵性/宗教实践)可能与差异有关(例如，抗逆转录病毒治疗(ARV)的坚持程度较低)。研究的目的和假设是：目的1：评估特定于CAM的保健行为，包括居住在提华纳和圣地亚哥的艾滋病毒阳性拉美裔人中盟军/替代保健人员(例如药剂师、非西方医学治疗师)对两国CAM的利用。假设1(H1)在HIV阳性的拉丁裔中将观察到更多地使用CAM，他们报告a)更频繁地越过美国边境，以及b)已经移民到提华纳或圣地亚哥(例如从墨西哥南部)。目的2：评估在艾滋病毒治疗利用和做法方面使用CAM的情况，包括与延迟进入艾滋病毒护理有关的因素(例如艾滋病毒耻辱)；以及居住在提华纳或圣地亚哥的艾滋病毒阳性拉美裔人使用和坚持抗逆转录病毒药物的情况。H2.a)与报告使用草药CAM的艾滋病毒阳性拉美人相比，不使用草药CAM的人更有可能接受抗逆转录病毒药物，并报告更高水平的抗逆转录病毒药物依从性；H2.b)与不定期参加宗教仪式的艾滋病毒阳性拉美人相比，定期参加宗教仪式的人更有可能接受抗逆转录病毒病毒；H2.c)与报告经历艾滋病毒相关污名的艾滋病毒阳性拉美人相比，没有报告经历艾滋病毒相关耻辱的人更有可能接受抗逆转录病毒。目的3：确定居住在提华纳或圣地亚哥的HIV阳性拉丁裔患者在沟通使用CAM方面的感知障碍和对临床医生的依从性，包括对临床医生沟通的满意度、对临床医生对报告使用CAM的反应的担忧以及对ARV有效性的感知；H3)在CAM使用者中，对临床医生沟通满意度较高的拉丁裔患者披露的CAM使用情况将高于报告满意度较低的拉丁裔患者。目的4：探索提供者和系统障碍，以文化有效的沟通在艾滋病毒拉丁美洲人的CAM和抗逆转录病毒的依从性。在目标1-3中，我们将对200名艾滋病毒拉美人(边境两侧各100人)进行由采访者管理的量化调查。AIM 4将通过采访边境两侧的20名艾滋病毒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距，并将导致干预措施，以增加对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：我们以社区为基础的参与性研究的目标是确定圣地亚哥/提华纳边境艾滋病毒阳性拉美人使用补充和替代医学(CAM)的性质和程度。在感染艾滋病毒的美国拉美裔人中，CAM的使用与抗逆转录病毒疗法(ARV)的延迟使用和较差的坚持有关，这可能会加剧艾滋病毒护理机会和健康结果方面的健康差距。这项研究将导致制定文化有效的干预措施，以改善面临健康差距的拉丁裔人获得和坚持艾滋病毒护理的机会。

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.