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

在美国对海地移民进行干预以改善艾滋病毒结果 项目总结 美国是世界上海地移民人数最多的国家，但人们对海地知之甚少 携带艾滋病毒的移民(HILWH)超出了TasP之前时代的已知范围，而且没有证据 已经制定了参与度和保持干预策略。为海地移民和其他人 出生在美国的外国人，艾滋病毒护理连续体绝不是连续的。延误诊断和治疗是 占主导地位；由于未得到满足的需求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威胁竞争。护理迟到只是又一种耻辱 情况；相交的柱头意味着无数的脸向下，闭合，或更糟。加入这个组合的是最近的 推动对护理的纵向和体验性方面的研究以及量身定制的参与战略的优先研究 到目前还没有从生物医学进步中受益的群体。从当前的时代中消失 干预发展是高水平线。基于对海地和南佛罗里达州20年的研究，南佛罗里达州拥有 美国最大比例的海地移民，我们建议进行一项研究，将HILWH带入当前 一代的研究。根据PA-20-141提出的R34源于我们最近与第一个 非洲裔美国人和西班牙裔美国人实施iEngage干预措施的社区适应 艾滋病毒携带者。IEngage Brief干预模式面向护理级联和问题解决 未得到满足的需求、耻辱、心理健康和其他社会生态信息-动机- 行为框架，利用激励访谈组件，并在以下方面显示出有效性 内在化的耻辱。我们建议将iEngage模式调整到迈阿密的HILWH，那里是Full 海地侨民经历的范围。我们研究的目标将是：用混合的方法产生多层次的 有关HILWH、利益相关方和 全方位提供者(目标1)；从文化上适应和评估海地移民iEngage的初步工作 在最近诊断的或非病毒抑制的成年人中进行准试验性试验的有效性(目标2)；以及 使用混合方法确定影响成果的多层次执行因素(目标3)。我们会适应 对社会文化制约敏感的光声技术在HILWH之间加强混合的方法。这个 这项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、调整和测试一种有希望的干预措施，专门针对他们在 作为疫情和散居海外的海地移民的中心。这项研究填补了这方面的单一空白 人口，回应NIH最近的联合出版物，优先适应对污名化的干预措施 人口，并为具有国家意义的R01铺平了道路。

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.