Intervening with Haitian Immigrants in the U.S. to Improve HIV Outcomes

对美国的海地移民进行干预以改善艾滋病毒感染结果

• 批准号: 10700451
• 负责人: JESSY G DEVIEUX
• 金额: $ 22.64万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700451
• 关键词: AIDS prevention; Address; Adult; Affect; African American; Award; Behavior Therapy; Behavioral; Caring; Client; Communities; Continuity of Patient Care; Country; Data; Dedications; Diagnosis; Effectiveness; Epidemic; Evaluation; Evidence based intervention; Face; Federally Qualified Health Center; Florida; Foundations; Funding; Generations; Gravitation; HIV; Haiti; Haitian; Health Personnel; Hispanic Populations; Home; Immigrant; Improve Access; Intervention; Intervention Trial; Joints; Latinx population; Legal; Literature; Measures; Mental Health; Methods; Minority; Modeling; Motivation; National Institute of Allergy and Infectious Disease; Outcome; Persons; Population; Positioning Attribute; Problem Solving; Production; Provider; Publications; Publishing; Quasi-experiment; Randomized; Reduce health disparities; Research; Research Personnel; Research Priority; Resources; Screening for cancer; Standardization; Stigmatization; Stroke; Techniques; Testing; United States; United States National Institutes of Health; Viral; Virus; Work; brief intervention; clinical research site; comorbidity; connected care; contextual factors; design; evidence base; experience; follow-up; implementation determinants; implementation intervention; improved; improved outcome; internalized stigma; motivational enhancement therapy; multi-component intervention; neglect; outcome disparities; pandemic disease; pilot test; preventive intervention; response; service providers; social; social culture; social determinants; social stigma; socioeconomics; stem; surveillance study; therapy development; transmission process

Intervening with Haitian Immigrants in the U.S. to Improve HIV Outcomes PROJECT SUMMARY The U.S. is home to the largest population of Haitian immigrants in the world, yet little is known about Haitian immigrants living with HIV (HILWH) beyond what was known in the pre-TasP era, and no evidence-based engagement and retention intervention strategies have been developed. For Haitian immigrants and other foreign-born in the U.S., the HIV care continuum is anything but continuous. Delay in diagnosis and treatment is dominant; disruption in care due to unmet needs is commonplace. The threat of a virus hidden from view competes with more visible socioeconomic and legal threats. Lateness in care is just one more stigmatizing situation; intersecting stigmas mean a myriad of faces downturned, closed, or worse. Into this mix is the recent push to prioritize research of the longitudinal and experiential aspects of care and tailor engagement strategies to groups not yet benefiting from “getting to zero” biomedical advancements. Missing from this current era of intervention development are HILWH. Based on two decades of research in Haiti and S. Florida, which holds the largest proportion of Haitian immigrants in the U.S., we propose a study that will bring HILWH into the current generation of research. This proposed R34 in response to PA-20-141 stems from our recent work with the first community adaptation of the iENGAGE intervention for implementation with African American and Hispanic people living with HIV. The iENGAGE brief intervention model is geared to the care cascade and problem-solves unmet needs, stigma, mental health and other comorbidities within a social-ecological information-motivation- behavioral framework, utilizing motivational interviewing components, and has shown effectiveness on internalized stigma. We propose to adapt the iENGAGE model to HILWH in Miami, which is home to the full range of the Haitian diaspora experience. The aims of our study will: use mixed methods to produce multi-level formative data on barriers to engagement, retention, and viral suppression across HILWH, stakeholders, and a full spectrum of providers (Aim 1); culturally adapt and evaluate a Haitian immigrant iENGAGE for preliminary efficacy in a quasi-experimental pilot among recently diagnosed or nonvirally suppressed adults (Aim 2); and identify multi-level implementation factors affecting outcomes using mixed methods (Aim 3). We will adapt photovoice techniques sensitive to sociocultural constraints among HILWH to enhance mixed methods. The study will bring a long-neglected immigrant group into the longitudinal scope of HIV Care Cascade (HCC) research and adapt and test a promising intervention specific to their persistent HIV outcome disparities in an epicenter of both the epidemic and the Haitian immigrant diaspora. The study fills singular gaps for this population, responds to NIH’s recent joint publication prioritizing adaptation of interventions for stigmatized populations, and prepares the way for an R01 of national significance.

对美国的海地移民进行干预以改善艾滋病毒感染结果 项目概要 美国是世界上海地移民最多的国家，但人们对海地却知之甚少 感染艾滋病毒的移民 (HILWH) 超出了 TasP 时代之前的已知范围，并且没有基于证据的 已经制定了参与和保留干预策略。对于海地移民和其他 对于在美国外国出生的人来说，艾滋病毒护理的连续性绝非连续的。延误诊断和治疗 主导的;由于需求未得到满足而导致护理中断的情况司空见惯。隐藏在视线之外的病毒威胁 与更明显的社会经济和法律威胁竞争。护理迟到只是另一种耻辱 情况;交叉的耻辱意味着无数的面孔低落、封闭，或更糟。最近的 推动优先研究护理的纵向和体验方面并定制参与策略 尚未从“归零”生物医学进步中受益的群体。当今时代缺失的 干预开发是HILWH。基于海地和南佛罗里达州二十年的研究，该州拥有 由于海地移民在美国所占比例最大，我们提出一项研究，将 HILWH 纳入当前的研究范围 一代的研究。针对 PA-20-141 提出的 R34 源于我们最近与第一个 iENGAGE 干预措施的社区适应，以供非裔美国人和西班牙裔实施 艾滋病毒感染者。 iENGAGE 简短干预模型适用于护理级联和解决问题 社会生态信息动机中未满足的需求、耻辱、心理健康和其他合并症 行为框架，利用动机访谈成分，并在以下方面显示出有效性 内在的耻辱。我们建议将 iENGAGE 模型应用于迈阿密的 HILWH，那里是完整的 海地侨民经历的范围。我们研究的目标是：使用混合方法产生多层次 有关 HILWH、利益相关者和社区的参与、保留和病毒抑制障碍的形成性数据 全方位的提供商（目标 1）；文化适应和评估海地移民 iENGAGE 进行初步评估 在最近诊断或非病毒抑制的成年人中进行准实验试点的效果（目标 2）；和 使用混合方法确定影响结果的多层次实施因素（目标 3）。我们会适应 光语音技术对 HILWH 中的社会文化限制敏感，以增强混合方法。这 研究将把长期被忽视的移民群体纳入艾滋病毒护理级联（HCC）的纵向范围 研究、调整和测试一项有前途的干预措施，专门针对其持续存在的艾滋病毒结果差异 是该流行病和海地移民散居地的中心。该研究填补了这方面的奇异空白 NIH 最近联合发表的出版物，该出版物优先考虑针对污名化人群采取干预措施，以此回应 人口，并为具有全国意义的 R01 做好准备。