A Sequential Mixed Methods Study Evaluating the Influence of Violence on HIV Care and Viral Suppression among Young Black and Latinx MSM

一项序贯混合方法研究评估暴力对年轻黑人和拉丁裔 MSM 的艾滋病毒护理和病毒抑制的影响

• 批准号: 10082309
• 负责人: Victoria Frye
• 金额: $ 27.59万
• 依托单位: NEW YORK BLOOD CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10082309
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Adherence; Affect; Affective; African American; Age; Alcohols; Anxiety; Area; Belief; Bicycling; Blood; CD4 Lymphocyte Count; Caring; Censuses; Characteristics; Color; Communities; Computer Assisted; Continuity of Patient Care; Data; Discrimination; Emotional; Ethnic Origin; Gays; HIV; HIV Seronegativity; HIV Seropositivity; HIV risk; HIV-1; Health; Health Insurance; Hispanics; Homicide; Individual; Institution; Intervention; Interview; Language; Latino; Location; Medical; Mental Depression; Methods; Minority; Moods; New York; New York City; Outcome; Participant; Patient Self-Report; Perception; Personal Satisfaction; Pharmaceutical Preparations; Planet Earth; Plasma; Policies; Population; Prevalence; Prevention strategy; Psychosocial Factor; Public Health; Qualitative Research; RNA; Race; Reporting; Research; Research Methodology; Risk; Risk Behaviors; Services; Sex Orientation; Social support; Structure; Surveys; Time; United States; Venipunctures; Violence; Viral; Viral Load result; Visit; aged; antiretroviral therapy; base; behavioral outcome; care outcomes; design; diaries; disparity reduction; experience; follow-up; health care disparity; health goals; improved; intimate partner violence; medical appointment; men; men who have sex with men; novel; patient-clinician communication; programs; prospective; psychological distress; psychosocial; racism; response; sexual identity; smartphone Application; social media; social stigma; therapy adherence; time use; urban area; violence exposure; visual media

Abstract Viral suppression is critical to the national HIV prevention strategy in the United States, where it is estimated that just about half of people living with HIV (PLWH) are virally suppressed. The vast majority of PLWH are men who have sex with men (MSM). There are marked race- and ethnicity-based disparities in HIV prevalence, care engagement, retention, and subsequent viral suppression among MSM. Compared with White MSM, HIV-infected Black and Latinx MSM are significantly less likely to achieve viral suppression. Relative to older Black and Latinx MSM living with HIV, Black and Latinx MSM aged 13-24 years have low rates of linkage to care, retention in care, and viral suppression. In addition to race- and sexual orientation-based discrimination, Black and Latinx MSM experience other forms of violence that may adversely impact HIV care-related outcomes, such as intimate partner violence and community violence. There are almost no studies that have simultaneously studied community violence (including stigma and discrimination) and intimate partner violence among young minority MSM. The overarching aim of the proposed sequential mixed methods research is to characterize, over time and space, experiences of violence (i.e., intimate partner and sexual, community, and race- and sexual orientation- based violence) and how these experiences influence HIV care among young Black and Latinx MSM living with HIV. These results will yield an empirical basis for interventions and policies to fill gaps in the care continuum among young Black and Latinx MSM. The Specific Aims of the study are: Aim 1: Geolocate the spaces where young Black and Latinx MSMLWH experience violence and characterize how they interpret and assess the impact of those experiences on health, well-being, and HIV care-related outcomes. Aim 2: Assess associations among violence experiences and HIV care-related outcomes over time and space. To achieve these aims, we will conduct a sequential mixed methods study. At baseline, 50 young Black and Latinx MSMLWH will complete a brief baseline computer-assisted survey instrument (CASI); a community asset and risk mapping using Google Earth; a blood draw; and a qualitative in-depth interview (IDI). Between the baseline visit and 3-month follow-up, participants will prospectively complete daily diaries and geospatial mapping, in real time, using a smartphone app, geolocating the precise times and locations of violence experiences and characterizing their emotional and other responses. At the 3-month follow-up, participants will complete another CASI, blood draw, and in-depth qualitative interview. With the CASI, diary, and app-based data, we will characterize statistical associations among participant-level violence experiences, subjective responses, area-level characteristics (via census data) and HIV care-related outcomes (self-reported ART adherence, medical appointment attendance, and HIV viral load, assessed via quantitative HIV-1 RNA by PCR). IDI data will contextualize mapping data, at baseline, and diary and app data, at follow-up. As an exploratory aim, we will ideate location-specific, visual- or social media-based messages to reduce exposure to violence and/or address the psychosocial impacts via a design charrette where preliminary results and exemplary campaigns are presented and novel ideas are generated and discussed.

抽象的 病毒抑制对于美国国家的艾滋病毒预防战略至关重要 据估计，只有大约一半的艾滋病毒（PLWH）被病毒抑制。绝大多数 PLWH是与男人发生性关系的男人（MSM）。艾滋病毒中有明显的基于种族和种族的差异 MSM之间的患病率，护理参与，保留和随后的病毒抑制。与 白色MSM，HIV感染的黑色和Latinx MSM明显降低了抑制病毒性的可能性。 相对于患有艾滋病毒的黑人和拉丁裔MSM，黑人和拉丁MSM年龄13-24岁 与护理，保留保留和抑制病毒的联系率。 除了基于种族和性取向的歧视之外，黑人和拉丁MSM还经历其他 可能对艾滋病毒护理相关的结果产生不利影响的暴力形式，例如亲密伴侣暴力和 社区暴力。几乎没有研究同时研究了社区暴力 （包括污名和歧视）以及年轻少数民族MSM的亲密伴侣暴力。 提出的顺序混合方法研究的总体目的是表征，随着时间的流逝和 空间，暴力经历（即亲密伴侣和性，社区以及种族和性取向 - 基于暴力）以及这些经历如何影响年轻的黑人和拉丁MSM的艾滋病毒护理 艾滋病病毒。这些结果将为干预措施和政策填补护理连续体的空白而产生经验基础 在年轻的黑人和拉丁MSM中。 该研究的具体目的是： 目标1：将年轻的黑色和拉丁裔MSMLWH经历暴力和特征的空间地理位置 他们如何解释和评估这些经历对健康，福祉和与艾滋病毒有关的影响 结果。 AIM 2：评估暴力经历和随着时间和空间与艾滋病毒护理相关的结果之间的关联。 为了实现这些目标，我们将进行连续的混合方法研究。在基线时，50岁的黑色 Latinx MSMLWH将完成简短的基线计算机辅助调查工具（CASI）；一个社区 使用Google Earth的资产和风险映射；抽血；以及定性的深入访谈（IDI）。之间 基线访问和3个月的随访，参与者将前瞻性地完成日记和地理空间 实时映射，使用智能手机应用程序，将暴力的精确时间和位置进行地理位置 经验和表征他们的情感和其他反应。在3个月的随访中，参与者将 完成另一种CASI，抽血和深入的定性访谈。与CASI，日记和基于应用的 数据，我们将表征参与者级暴力经验之间的统计关联，主观 响应，面积级别的特征（通过人口普查数据）和与艾滋病毒相关的结果（自我报告的艺术 依从性，医疗预约出勤和HIV病毒负荷，通过定量HIV-1 RNA评估 PCR）。 IDI数据将在基线时将映射数据以及随访时的日记和应用程序数据上下文化。作为 探索目的，我们将构想特定于位置的，视觉或社交媒体的消息，以减少接触 暴力和/或通过初步结果和 提出了示例性的运动，并产生和讨论新颖的想法。