A mixed methods study of syndemic factors associated with social support and viral suppression among Black men who have sex with men (MSM) in Florida".

项目摘要 南方男男性行为者(MSM)的新艾滋病毒诊断率最高(48%)， 2018年，艾滋病毒感染率(31%)在所有种族的男男性接触者中排名第二。此外，种族差距 在病毒抑制方面，与52%的感染艾滋病毒的黑人MSM相比，实现了病毒抑制 到61%的白人男男性接触者。一项广泛的研究已经确定了多种共生的心理社会因素 以及导致艾滋病毒诊断、流行率和预后存在种族差异的结构性因素 黑人男同性恋。这种组合构成了一个共性，即“2+因素或健康状况的相互作用” 增加黑人男男性接触者中的艾滋病毒。与此同时，越来越多的证据表明，社会支持是一种影响 在黑人男男性接触者中的病毒抑制修饰物。到目前为止，还没有研究试图 确定佛罗里达州感染艾滋病毒的黑人MSM亚群，他们可以从共同的生物行为中受益 艾滋病毒干预，以改善社会支持和病毒抑制的基础上，他们的共同特点。因此， K01奖项的首要目标是为我提供资源、培训、指导和知识 需要审查公共卫生、药物使用和艾滋病毒的交叉性，以及共同研究。在这 建议，我将采用解释性顺序混合方法设计来实现以下具体目标 包括：1)应用潜在类别分析(LCA)来识别异质同源类别 在感染艾滋病毒的黑人男男性接触者中；1b)扩展现有文献，以审查两者之间的联系 社会群体和人口统计；2)在评估社会支持的量表上验证社会群体；3) 病毒学基线水平和一年变化量的综合类分组差异探讨 压抑；以及4)应用半结构化访谈来验证量化结果并将其与背景联系起来。 这些目标将通过利用现有数据、参与者和正在进行的 NIAAA资助的观察性纵向研究(U24AA022002)和对20名黑人男男性接触者的样本访谈 佛罗里达州的艾滋病毒携带者。这个K01应用程序将建立在我在艾滋病毒外展、公共卫生、定性 与物质使用和艾滋病毒有关的研究和临床干预研究，并接受高级培训：应用 黑人MSM的共性框架，用生命周期分析来模拟黑人MSM的共性条件，招募 黑人男男性接触者进入生物行为HIV研究，确定有效的生物行为HIV干预措施和策略 改善这一人群中的社会支持和病毒抑制，并进行负责任的研究。 监督这次培训的是一个多元化的跨学科导师团队，每个导师都将带来独特的 专业领域和多年合作：罗伯特·库克博士和埃里克·施里姆肖博士(共同主要导师)和 泰凡妮·戴尔博士、马蒂娅·普洛斯佩里博士、迈克尔·马西斯克博士、谢尔顿·菲尔兹博士和妮可·恩尼斯博士(共同导师)。这个 建议的K01奖将使我成为一名具有跨学科背景的独立科学家 旨在减少黑人男男性接触者中艾滋病毒健康差距的研究计划。

Project Abstract Black men who have sex with men (MSM) in the South had the highest rate of new HIV diagnoses (48%) and the 2nd highest rate of HIV prevalence (31%) among MSM of all races in 2018. Furthermore, racial disparities exist in terms of viral suppression, with 52% of Black MSM living with HIV achieving viral suppression compared to 61% of White MSM. An extensive body of research has identified multiple co-occurring psychosocial factors and structural factors that contribute to racial disparities in HIV diagnoses, prevalence, and outcomes among Black MSM. This combination constitutes a syndemic, “the interaction of 2+ factors or health conditions” that increase HIV among Black MSM. At the same time, mounting evidence suggests social support as an effect modifier of viral suppression among Black MSM experiencing a syndemic. To date, no study has sought to identify the subgroups of Black MSM living with HIV in Florida who could benefit from a shared biobehavioral HIV intervention to improve social support and viral suppression based on their shared characteristics. Therefore, the overarching goal of the K01 award is to provide me with the resources, training, mentoring and knowledge needed to examine the intersectionality of public health, substance use and HIV, and syndemic research. In this proposal, I will employ the explanatory sequential mixed method design to accomplish the specific aims which include: 1a) application of latent class analyses (LCA) for the identification of heterogeneous syndemic classes among Black MSM living with HIV; 1b) expansion of existing literature to examine the association between syndemic classes and demographics; 2) validation of syndemic classes on scales assessing social support; 3) exploration of syndemic class group differences on measures of baseline level and one-year change in viral suppression; and 4) application of semi-structured interviews to validate and contextualize quantitative findings. These goals will be accomplished by leveraging existing data, participants, and resources from an ongoing NIAAA-funded observational longitudinal study (U24AA022002) and interviewing a sample of 20 Black MSM living with HIV in Florida. This K01 application will build on my expertise in HIV outreach, public health, qualitative research, and clinical intervention research related to substance use and HIV with advanced training in: applying a syndemic framework to Black MSM, using LCA to model syndemic conditions among Black MSM, recruiting Black MSM into biobehavioral HIV research, identifying effective biobehavioral HIV interventions and strategies to improve social support and viral suppression among this population, and responsible conduct of research. Overseeing this training are a diverse and interdisciplinary team of mentors, each of whom will bring unique areas of expertise and years of collaboration: Drs. Robert Cook and Eric Schrimshaw (co-primary mentors) and Drs. Typhanye Dyer, Mattia Prosperi, Michael Marsiske, Sheldon Fields, and Nicole Ennis (co-mentors). The proposed K01 award will allow me to establish myself as an independent scientist with an interdisciplinary research program aimed at reducing health disparities in HIV among Black MSM.