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

项目摘要/摘要 尽管在美国扩大了以证据为基础的干预措施以结束艾滋病毒流行(EHE)，但有几个 受艾滋病毒影响最严重的社区落后于EHE到2030年将艾滋病毒感染减少90%的目标。 黑人/非裔美国人(AA)艾滋病毒携带者(PWH)在美国艾滋病毒诊断中占很大比例 具体地说，美国AAs占2019年报告的所有新艾滋病毒诊断病例的42%，尽管仅包括 占美国总人口的13%。此外，在整个HIV感染者中，AA PWH的预后较差 护理连续体，包括更多的艾滋病毒未确诊患者，与艾滋病毒护理的联系较差，并保留在艾滋病毒护理中， 接受抗逆转录病毒治疗(ART)的比率更低，ART依从率更低， 实现病毒抑制。而社区凝聚力很强的AA威尔斯亲王医院报告的艾滋病毒结果呈阳性 (例如，高ART依从性、病毒抑制)，在AA之间社区凝聚力较低的地区 威尔斯亲王医院，这些人可能会被忽视，尽管有较弱社区的独特经历 凝聚力。因此，当务之急是将研究的重点放在调查心理社会决定因素上。 社区凝聚力低的AA威尔斯亲王医院的健康状况。我们已经证明，高度的心理社会资源 (例如，复原力、个人控制力、社会支持)对健康结果有积极影响，如药物治疗 坚持与身心健康相关的生活质量。然而，这些以量化为基础的 研究可能无法解释缺乏强大社区的AA威尔斯亲王医院独特的个人经历 凝聚力。评估影响健康的心理社会决定因素、服药依从性和 医疗保健利用对于确定AA PWH健康结局差的风险最大至关重要。因此， 拟议的F31项目将跟进AA PWH的初步研究，以便：1)表征ART的依从性 低再生障碍性贫血地区再生障碍性肝炎患者的行为轨迹及其与HIV特征的关系 社区凝聚力；2)确定与抗逆转录病毒治疗相关的可改变的健康心理社会决定因素 在AA社区凝聚力较低的EHE辖区内AA PWH之间的坚持轨迹；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， 在AA较低的EHE辖区的AA PWH中，弹性)、ART依从性和医疗保健利用率 社区凝聚力。建议的研究将使用先进的定性和定量研究方法。 来考察这些关系。通过F31机制提供的机会将有助于申请者 职业发展--成为致力于研究行为的独立调查者 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.