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

项目总结 在人类免疫缺陷病毒(HIV)护理和坚持抗逆转录病毒治疗中实现高保留率 治疗导致高病毒抑制率，这不仅降低了死亡率，提高了生活质量， 在感染艾滋病毒的人中，但也减少了艾滋病毒在受影响社区内的传播。艾滋病病毒 妇女的护理效果一直不佳；2014年，非洲的病毒抑制率为52.6% 美国人中，白人占57.9%，拉丁裔占59.8%，而白人男性占66.0%。 感染艾滋病毒的妇女更有可能面临儿童护理等成功的艾滋病毒护理障碍 负担、虐待和极度贫困。此外，妇女，特别是有色人种妇女，可以面对 多层次的耻辱，包括与他们的种族、民族、艾滋病毒感染、吸毒和贫困有关的耻辱 状态。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不是为了 满足女性的特殊需求。在全国范围内提出了实施以妇女为中心的艾滋病毒护理的建议， 在国际上，这是满足妇女需求的一种方式。然而，这一想法并没有很好地在 艾滋病毒护理，还没有在包括瑞安在内的美国卫生保健系统的背景下进行审查 白色计划，该计划为美国65%的艾滋病毒携带者提供服务。我们的中心假设是 一个系统越以妇女为中心，艾滋病毒护理保留和病毒抑制的可能性就越高 在女性中。此应用程序的目标是确定有效的提供者和以妇女为中心的系统 瑞安·怀特计划内的艾滋病毒护理做法对艾滋病毒护理保留和病毒感染产生积极影响 在经历社会文化挑战的妇女中的压抑。我们将通过一个 迈阿密-戴德县登记的女性患者入院和账单数据的混合方法研究 瑞安·怀特计划，对病例经理、医疗保健提供者、 管理人员、艾滋病毒携带者和妇女，并对迈阿密600名艾滋病毒携带者妇女进行了调查- 戴德县瑞安·怀特项目。我们提出了以下三个具体目标：1)识别社会文化 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 对非裔美国人、海地人和拉丁裔妇女产生不同的影响；2)确定当前和潜在的情况 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，可减轻不利影响 艾滋病毒护理保留和抗逆转录病毒治疗依从性的社会文化因素；3)确定具体的卫生保健 提供者和系统以妇女为中心的艾滋病毒护理做法，这些做法对艾滋病毒护理保留影响最大， 在所有妇女以及非裔美国人、海地人和拉丁裔妇女中坚持和抑制病毒传播。这 该项目涉及国家艾滋病毒/艾滋病战略目标，以增加获得护理的机会，改善卫生结果， 和减少与艾滋病毒相关的健康差距和跨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.