Engagement in Care and Emotional Support in the Context of Interpersonal Trauma among Latino Immigrant Men with HIV: A Mixed-Methods Investigation

提案摘要 由于交叉移民，艾滋病毒，种族和性少数群体的地位，拉丁美洲移民男子艾滋病毒 （LIMWH）处于高水平暴露于人际创伤（IT）的风险中。信息技术是健康的社会决定因素 对受害者的生物、心理、社会和情感健康产生不利影响， 艾滋病毒感染者（PLWH）中的差异，包括精神疾病和护理参与不足（EIC）。 拉丁裔男性受艾滋病毒和EIC相关结果（如保留护理）的影响不成比例 远低于美国和国际目标。大约37 - 43%的拉丁美洲人新诊断出艾滋病毒 是那些在移民之前、期间和之后面临更大的IT风险的移民，例如暴力。拉丁裔 PLWH对精神卫生保健的参与度也很低，并且有获得低情感支持（ES）的风险-a 保护性资源，以缓冲负面的心理社会，情绪和行为的影响。 不幸的是，很少有人知道IT对LIMWH中EIC的影响以及保护性心理社会因素。 在IT环境中影响LIMWH中EIC的资源。为了更好地理解这些关系， 在LIMWH中，本研究将利用最近的患者健康参与（PHE）模型， 心理和情感过程中所涉及的EIC。这种探索性的顺序混合的目的 方法研究的目的是丰富了解LIMWH在EIC和IT方面的经验， 艾滋病护理团队可以促进的心理社会资源，以改善EIC和心理社会健康， 目标1a：了解LIMWH（n = 20）的经验， IT以及影响他们EIC的心理社会和情感影响。目标1b：了解前景 艾滋病毒护理团队成员（n = 15）在IT和心理社会影响方面护理LIMWH， 情绪对EIC的影响。目的：2：研究接触信息技术与 LIMWH（n = 100）中EIC的连续性，同时控制个体和人际协变量。目标3： 在控制个体的情况下，评估LIMWH中ES与EIC连续体之间的关联 和人际协变量。拟议的研究将使用半结构化定性研究的初步结果， 与LIMWH和来自巴尔的摩-华盛顿都会区的艾滋病毒护理提供者的访谈， 定量调查评估IT、EIC和ES之间的关联。定性分析的框架方法 数据分析将用于确定调查的主题和关键的心理变量， 随后使用多变量逻辑回归模型、模型检验和亚组分析进行分析。这 结合LIMWH和艾滋病毒提供者观点的迭代方法将加强 研究结果并为LIMWH未来的研究和心理社会干预提供信息，以促进最佳的EIC， 社会心理健康，以及在结束艾滋病毒流行方面取得进展。

PROPOSAL SUMMARY Due to intersecting immigration, HIV, racial, and sexual minority statuses Latino immigrant men with HIV (LIMWH) are at risk for high levels of exposure to interpersonal trauma (IT). IT is a social determinant of health adversely impacting victims’ biopsychosocial and emotional health and has been associated with numerous disparities including mental illness and poor engagement in care (EIC) among people living with HIV (PLWH). Latino men are disproportionately impacted by HIV, and EIC-related outcomes such as retention in care among Latinos are well below US and international goals. About 37-43% of Latinos newly diagnosed with HIV are immigrants who face increased risk for IT such as violence before, during, and after migration. Latino PLWH also have low engagement in mental health care and are at risk for low emotional support (ES)—a protective resource shown to buffer the negative psychosocial, emotional, and behavioral impacts of IT. Unfortunately, little is known about the impact of IT on EIC among LIMWH and the protective psychosocial resources that influence EIC among LIMWH in the context of IT. To better understand these relationships among LIMWH, this study will utilize the recent Patient Health Engagement (PHE) model describing psychological and emotional processes involved in EIC. The purpose of this exploratory sequential mixed methods study is to generate a rich understanding of the experiences of LIMWH with EIC and IT and the psychosocial resources that HIV care teams can promote to improve EIC and psychosocial well-being among LIMWH by addressing the following specific aims: Aim 1a: Understand the experiences of LIMWH (n=20) with IT and the psychosocial and emotional influences that impact their EIC. Aim 1b: Understand the perspectives of HIV care team members (n=15) caring for LIMWH regarding the impact of IT and psychosocial and emotional influences on EIC in this population. Aim: 2: Examine the association between exposure to IT on the continuum of EIC among LIMWH (n=100) while controlling for individual and interpersonal covariates. Aim 3: Evaluate the association between ES and the continuum of EIC among LIMWH while controlling for individual and interpersonal covariates. The proposed study will use preliminary results from semi-structured qualitative interviews with LIMWH and HIV care providers from the Baltimore-Washington metro area to inform a quantitative survey assessing the associations between IT, EIC and ES. The Framework method of qualitative data analysis will be used to identify themes and key psychosocial variables to be included in the survey and subsequent analysis using multivariable logistic regression models, model testing, and subgroup analysis. This iterative approach incorporating the perspectives of LIMWH and HIV providers will strengthen the validity of the findings and inform future research and psychosocial interventions among LIMWH to promote optimal EIC, psychosocial wellbeing, and progress towards Ending the HIV Epidemic.