Women-centered HIV care practices that facilitate HIV care retention and viral suppression in the presence of adverse sociocultural factors

项目摘要 继续接受人体免疫缺陷病毒（艾滋病毒）治疗和坚持抗逆转录病毒治疗的比率高 治疗导致高比率的病毒抑制，这不仅降低了死亡率并提高了生活质量， 在艾滋病毒感染者中，这不仅可以减少艾滋病毒在受影响社区内的传播。艾滋病毒 妇女的护理结果不理想; 2014年，非洲妇女的病毒抑制率为52.6%， 美国人，白人57.9%，拉丁美洲人59.8%，而白色男性66.0%。 感染艾滋病毒的妇女更有可能在儿童保育等艾滋病毒护理方面遇到障碍 比男性更重的负担、虐待和极端贫困。此外，妇女，特别是有色人种妇女， 多层次的耻辱，包括与种族、民族、艾滋病毒感染、吸毒和贫困有关的耻辱 status.部分原因是艾滋病毒流行最初主要影响男性，艾滋病毒护理系统的设计并不是为了 满足女性的特殊需求。在全国范围内提议实施以妇女为中心的艾滋病毒护理， 在国际上作为解决妇女需求的一种方式。然而，这一想法并没有得到很好的实施， 艾滋病护理和尚未审查的背景下，美国的医疗保健系统，包括瑞安 白色计划，该计划为美国65%的艾滋病毒感染者提供服务。我们的核心假设是， 一个系统越是以妇女为中心，保留艾滋病毒护理和抑制病毒的可能性就越高 在女性中。这项申请的目的是确定有效的提供者和系统， 瑞安白色计划中的艾滋病毒护理实践对艾滋病毒护理保留和病毒感染产生了积极影响 在遭受社会文化挑战的妇女中受到压制。我们将通过以下方式实现这一目标： 一项混合方法研究，检查了迈阿密-戴德县登记的妇女的患者摄入量和账单数据 瑞安白色计划，进行深入采访的情况下，经理，医疗保健提供者， 管理人员和艾滋病毒感染者，并对迈阿密的600名艾滋病毒感染者进行了调查， 戴德县瑞安白色计划。我们提出以下三个具体目标：1）确定社会文化 影响艾滋病毒护理保留和病毒抑制的因素，包括妇女特有的因素和 对非洲裔美国人、海地人和拉丁美洲妇女产生不同的影响; 2）确定目前和潜力 卫生保健提供者和系统以妇女为中心的艾滋病毒护理做法，可能会减轻不利的影响， 社会文化因素对艾滋病毒护理保留和抗逆转录病毒疗法坚持; 3）确定具体的保健 提供者和系统以妇女为中心的艾滋病毒护理做法，对艾滋病毒护理的保留影响最大， 在所有女性以及非裔美国人、海地人和拉丁裔女性中，这 该项目涉及国家艾滋病毒/艾滋病战略的目标，以增加获得护理的机会，改善健康结果， 减少艾滋病毒相关的健康差距，跨NIH艾滋病毒相关研究计划呼吁进行研究 促进艾滋病毒护理参与，减少治疗结果的差异。

PROJECT SUMMARY Achieving high rates of retention in human immunodeficiency virus (HIV) care and adherence to antiretroviral therapy leads to high rates of viral suppression, which not only reduces mortality and improves quality of living, among people living with HIV infection, but also reduces HIV transmission within affected communities. HIV care outcomes among women have been suboptimal; in 2014, viral suppression was 52.6% among African Americans, 57.9% among Whites, and 59.8% among Latinas compared with 66.0% among White men. Women living with HIV infection are more likely to face barriers to successful HIV care such as child care burden, abuse, and extreme poverty than men. In addition, women, in particular women of color, can face multiple layers of stigma including those related to their race, ethnicity, HIV infection, drug use, and poverty status. Partly because the HIV epidemic initially affected mostly men, the HIV care system is not designed to meet women's special needs. Implementing women-centered HIV care has been proposed nationally and internationally as a way to address women's needs. However, this idea has not been well operationalized for HIV care and has not been examined in the context of the United States health care system including the Ryan White Program, which serves 65% of women living with HIV in the United States. Our central hypothesis is that the more women-centric a system is, the higher the likelihood of HIV care retention and viral suppression among women. The objective of this application is to identify effective provider and system women-centered HIV care practices within the Ryan White Program that positively influence HIV care retention and viral suppression among women experiencing sociocultural challenges. We will accomplish this objective with a mixed methods study examining patient intake and billing data from women enrolled in the Miami-Dade County Ryan White Program, conducting in-depth interviews with case managers, health care providers, administrators, and women living with HIV, and conducting a survey of 600 women living with HIV in the Miami- Dade County Ryan White Program. We propose the following three specific aims: 1) Identify sociocultural factors that influence HIV care retention and viral suppression, including those unique to women and those having a differential impact on African American, Haitian and Latina women; 2) Ascertain current and potential health care provider and system women-centered HIV care practices that may mitigate the effect of adverse sociocultural factors on HIV care retention and antiretroviral therapy adherence; 3) Identify specific health care provider and system women-centered HIV care practices that most strongly influence HIV care retention, adherence, and viral suppression among all women and in African American, Haitian and Latina women. This project addresses the National HIV/AIDS Strategy goals to increase access to care, improve health outcomes, and reduce HIV-related health disparities and the Trans-NIH Plan for HIV-Related Research call for research to promote HIV care engagement and to reduce disparities in treatment outcomes.