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

项目总结/文摘

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.