Examining Social Determinants of Antiretroviral Adherence Trajectories among African American Adults with HIV

项目总结/摘要 尽管美国加强了循证干预措施，以结束艾滋病毒流行病（EHE），几 受艾滋病毒影响最严重的社区落后于EHE到2030年将艾滋病毒感染率降低90%的目标。 黑人/非洲裔美国人（AA）艾滋病毒感染者（PWH）占艾滋病毒诊断的很大比例， 美国具体而言，AA占2019年报告的所有新艾滋病毒诊断的42%，尽管仅包括 占美国总人口的13%。此外，AA PWH在整个HIV中的结局沿着较差 护理连续性，包括更多的艾滋病毒感染者未被诊断，与艾滋病毒护理的联系和保留情况较差， 接受抗逆转录病毒治疗（ART）的比率较低，ART依从率较低， 实现病毒抑制。社区凝聚力强的机管局威尔斯亲王医院在爱滋病方面的成效良好 (e.g.,抗逆转录病毒治疗依从性高，病毒抑制），在AA之间社区凝聚力低的地区 威尔斯亲王医院，这些人可能会被忽视，尽管有独特的经验，有较弱的社区 凝聚力因此，必须将研究工作集中在调查社会心理决定因素上， 社区凝聚力低的机管局威尔斯亲王医院的健康情况。我们已经证明，高心理社会资源 (e.g.,弹性，个人掌握，社会支持）积极影响健康结果，如药物治疗 依从性以及与身心健康相关的生活质量。然而，这些基于数量的 研究未必能解释机管局威尔斯亲王医院独特的个人经历， 凝聚力评估健康的社会心理决定因素、药物依从性和 医疗服务利用率对于确定AA PWH最有可能导致不良健康结果至关重要。因此 拟议的F31项目将跟进AA PWH的初步研究，以便：1）描述ART依从性 艾滋病毒感染轨迹及其与艾滋病毒特征之间的关系，在一个艾滋病毒感染率低的EHE管辖区 社区凝聚力; 2）确定与ART相关的可改变的健康心理社会决定因素 在具有低AA社区凝聚力的EHE管辖区中，AA PWH之间的依从性轨迹;以及3） 探索健康的积极的可改变的心理社会决定因素之间的定性关系（例如， 弹性），ART依从性和医疗保健利用率，在EHE管辖区的AA PWH低AA 社区凝聚力。建议的研究将采用先进的定性和定量研究方法 来研究这些关系。通过F31机制提供的机会将有助于申请人 专业发展，成为一名独立的调查员，致力于研究行为 医学主题，如不同人群健康结果的心理社会决定因素。

PROJECT SUMMARY/ABSTRACT Despite the scaling up of evidence-based interventions to End the HIV Epidemic (EHE) in the U.S., several communities most affected by HIV lag behind the EHE goal of reducing HIV infections by 90% by 2030. Black/African American (AA) people with HIV (PWH) account for a large proportion of HIV diagnoses in the U.S. Specifically, AAs represented 42% of all new HIV diagnoses reported in 2019 despite comprising only 13% of the total United States population. Furthermore, AA PWH have poorer outcomes along the entire HIV care continuum, including a greater number with undiagnosed HIV, poorer linkage to and retention in HIV care, lower rates of receiving antiretroviral therapy (ART), lower ART adherence rates, and lower likelihood of achieving viral suppression. While AA PWH with strong community cohesion report positive HIV outcomes (e.g., high ART adherence, viral suppression), in regions where there is low community cohesion among AA PWH, these individuals may be overlooked, despite the unique experience of having weaker community cohesion. As such, it is imperative to focus research efforts on investigating psychosocial determinants of health among AA PWH with low community cohesion. We have shown that high psychosocial resources (e.g., resilience, personal mastery, social support) positively influences health outcomes such as medication adherence, and physical and mental health-related quality of life. Nevertheless, these quantitative-based studies may not account for the unique, individual experiences of AA PWH who lack strong community cohesion. Assessing the relationships between psychosocial determinants of health, medication adherence, and healthcare utilization is critical toward identifying AA PWH most at-risk for poor health outcomes. Accordingly, the proposed F31 project will follow-up on an initial study of AA PWH in order to: 1) Characterize ART adherence trajectories and their associations with HIV characteristics among AA PWH in an EHE jurisdiction with low AA community cohesion; 2) Identify modifiable psychosocial determinants of health associated with ART adherence trajectories among AA PWH in an EHE jurisdiction with low AA community cohesion; and 3) Explore qualitative relationships between positive modifiable psychosocial determinants of health (e.g., resilience), ART adherence, and healthcare utilization among AA PWH in an EHE jurisdiction with low AA community cohesion. The proposed research will use advanced qualitative and quantitative research methods to examine these relationships. The opportunities afforded via this F31 mechanism will facilitate the applicant’s professional development toward becoming an independent investigator dedicated to researching behavioral medicine topics such as psychosocial determinants of health outcomes among diverse populations.