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

干预在美国的海地移民以改善艾滋病毒结果 项目摘要 美国是世界上海地移民人口最多的国家，但人们对海地人知之甚少。 艾滋病毒感染者（HILWH）的数量超过了前TasP时代的已知数量， 制定了参与和留用干预战略。海地移民和其他 在美国出生的外国人艾滋病毒护理的连续性绝不是连续性的。延误诊断和治疗是 占主导地位;由于需求得不到满足而中断护理是司空见惯的。隐藏在视线之外的病毒的威胁 与更明显的社会经济和法律的威胁竞争。护理的延迟只是一个更耻辱 交叉的柱头意味着无数的脸向下，关闭，或更糟。最近， 推动优先研究护理的纵向和经验方面，并制定参与战略 还没有从“归零”生物医学进步中受益的群体。在这个时代， 干预发展是HILWH。基于在海地和S.佛罗里达， 海地移民在美国的比例最大，我们提出了一项研究， 一代研究。根据PA-20-141提出的R34源于我们最近对第一个 社区调整iENGAGE干预措施，以便在非洲裔美国人和西班牙裔美国人中实施 艾滋病毒感染者。iENGAGE简短干预模式适合于护理级联和问题解决 未满足的需求，耻辱，心理健康和社会生态信息动机中的其他共病， 行为框架，利用动机访谈组件，并已显示出有效性， 内在的耻辱感我们建议将iENGAGE模型应用于迈阿密的HILWH，该地区拥有完整的 一系列海地侨民的经历。本研究的目的是：使用混合方法产生多层次的 关于HILWH、利益相关者和 全方位的供应商（目标1）;文化适应和评估海地移民iENGAGE初步 在最近诊断或非病毒抑制的成人中进行的准实验性试验的有效性（目标2）;以及 使用混合方法识别影响结果的多层次实施因素（目标3）。我们会适应的 光声技术敏感的社会文化制约因素之间的HILWH，以加强混合方法。的 一项研究将把一个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、调整和测试一种有希望的干预措施，专门针对他们在一个国家中持续存在的艾滋病毒结果差异， 海地是这一流行病和海地移民散居地的中心。这项研究填补了这方面的空白 人口，回应NIH最近的联合出版物，优先考虑适应污名化的干预措施 人口，并为具有国家意义的R 01铺平道路。

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.