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

检查非洲裔美国成人艾滋病毒感染者抗逆转录病毒药物依从轨迹的社会决定因素

• 批准号: 10700611
• 负责人: Vanessa Bianca Serrano
• 金额: $ 4万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700611
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Affect; African American; African American population; Anti-Retroviral Agents; Behavioral Medicine; Black Populations; Black race; California; Caring; Characteristics; Classification; Communities; Community Healthcare; Continuity of Patient Care; Data; Dedications; Descriptor; Development; Disease Outcome; Epidemic; Evidence based intervention; Face; Fellowship; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV/AIDS; Health; Individual; Intervention; Longevity; Medical; Mental Health; Outcome; Pattern; Persons; Population; Population Heterogeneity; Psychosocial Influences; Public Health; Qualitative Research; Reporting; Research; Research Methodology; Research Personnel; Risk; Role; Self Efficacy; Severity of illness; Social support; Strategic Planning; Subgroup; Text Messaging; Time; United States; Viral; Viral Load result; adherence rate; antiretroviral therapy; cohesion; experience; follow-up; health care availability; health care service utilization; health determinants; health disparity; health management; health related quality of life; improved; medication compliance; physical conditioning; poor health outcome; psychosocial; psychosocial resources; regional difference; resilience; scale up; social determinants; social stigma; text messaging intervention; therapy adherence; two way texting

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.

项目摘要/摘要 尽管在美国终止了基于证据的干预措施，以结束美国的艾滋病毒流行（EHE），但有几个 受艾滋病毒影响最大的社区在2030年将艾滋病毒感染降低90％的目标之后。 黑人/非裔美国人（AA）患有艾滋病毒（PWH）的人在大部分艾滋病毒诊断中占很大比例 美国特别是AAS占2019年所有新艾滋病毒诊断的42％，仅完成 占美国总人口的13％。此外，AA PWH在整个艾滋病毒中的结果较差 护理连续体，包括更多未诊断艾滋病毒的人数，与艾滋病毒护理中的较差和保留率， 较低的接受抗逆转录病毒疗法（ART），较低的艺术依从性率和较低的可能性 实现病毒抑制。而社区凝聚力强的AA PWH报告了积极的HIV成果 （例如，在AA之间存在较低社区凝聚力的地区，高级艺术依从性，病毒抑制） PWH，这些人可能会被忽略，dospite拥有较弱的社区的独特经历 凝聚。因此，必须将研究工作重点放在调查的社会心理决定者上 社区凝聚力较低的AA PWH的健康状况。我们已经证明了高的社会心理资源 （例如，韧性，个人精通，社会支持）对诸如药物的健康成果产生积极影响 依从性以及与身体健康相关的生活质量。然而，这些基于定量的 研究可能无法说明缺乏强大社区的AA PWH的独特，个人经历 凝聚。评估健康，药物依从性和 医疗保健利用对于确定AA PWH的健康状况不佳至关重要。根据 拟议的F31项目将对AA PWH的初步研究进行跟进：1）表征艺术依从性 轨迹及其与低AA管辖范围内AA PWH之间的艾滋病毒特征的关联 社区凝聚力； 2）确定与艺术相关的健康心理社会心理决定者 AA PWH的依从性轨迹在AA社区凝聚力低下的管辖权中； 3） 探索积极可修改的心理社会心理决定者之间的定性关系（例如 AA PWH的AA PWH的弹性，艺术依从性和医疗保健利用率低。 社区凝聚力。拟议的研究将使用先进的定性和定量研究方法 检查这些关系。通过这种F31机制提供的机会将促进申请人的 成为专门研究行为的独立调查员的专业发展 医学主题，例如潜水员人群中健康结果的社会心理决定者。