Identifying barriers to diabetes and HIV co-management in vulnerable populations

确定弱势群体中糖尿病和艾滋病毒共同管理的障碍

• 批准号: 8993615
• 负责人: Kartika Palar
• 金额: $ 15.86万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8993615
• 关键词: Address; Adherence; Affect; Age; Alcohol or Other Drugs use; Alcohols; American; Anti-Retroviral Agents; Behavior Therapy; Behavioral; Blood Pressure; Cardiovascular Diseases; Chronic; Chronic Disease; Clinical; Clinical Sciences; Communities; Comorbidity; Complex; Data; Diabetes Mellitus; Diagnosis; Disease; Disease Outcome; Economic Factors; Economics; Endocrinologist; Epidemic; Equation; Face; Female; Food; Food deprivation (experimental); Fostering; Gender; Glycosylated hemoglobin A; Goals; Guidelines; HIV; Health; Health Policy; Healthcare; Individual; Intervention; Interview; K-Series Research Career Programs; Kidney; Knowledge; Measures; Mediating; Mentored Research Scientist Development Award; Mentors; Metabolic; Modeling; Outcome; Persons; Physical activity; Policies; Population; Prevalence; Prospective Studies; Proxy; Race; Relative (related person); Research; Research Infrastructure; Research Personnel; Research Training; Role; Self Efficacy; Self Management; Site; Social Impacts; Social isolation; Specific qualifier value; Stream; Testing; Training; United States; Viral; Viral Load result; Vulnerable Populations; Woman; Work; antiretroviral therapy; base; behavioral/social science; blood lipid; cardiovascular risk factor; career; cohort; contextual factors; deprivation; diabetes control; diabetes management; empowerment; fasting glucose; glycemic control; good diet; health disparity; improved; low socioeconomic status; men; population health; programs; public health relevance; smoking cessation; social; social health determinants; socioeconomics; theories; therapy adherence; therapy design; trial design

 DESCRIPTION (provided by applicant): A significant challenge facing the HIV epidemic is the increasing burden of chronic diseases, including diabetes mellitus (DM) and cardiovascular disease, requiring individuals to self-manage multiple complex conditions simultaneously. Furthermore, social and economic vulnerability is likely to intensify barriers to DM and HIV co-management. Yet limited evidence exists to understand the challenges individuals face in co- managing HIV and DM, and the specific ways that social and economic vulnerability (e.g. financial deprivation, food insecurity) influence HIV/DM co-management and subsequent health outcomes. In particular, HIV- infected women are disproportionately impacted by socioeconomic deprivation, indicating they may face even greater structural barriers to HIV/DM co-management. Responding to this challenge calls for leaders committed to and capable of conducting cross-cutting research bridging social/behavioral and clinical sciences, and HIV and DM-specific research streams. This K01 Mentored Research Scientist Development Award will build upon my previous training in health policy and previous research on HIV and economic vulnerability to enable me to become an independent investigator addressing the interplay of diabetes, HIV and social determinants of health. To achieve this goal I will obtain training and mentoring in clinical and population health aspects of DM; theories and measures of adherence and disease self- management; advanced statistical approaches including structural equation modeling; and intervention and trial design. I will be supported by a distinguished panel of mentors and advisors including HIV clinicians, social and behavioral researchers, endocrinologists and statisticians, led by Dr. Sheri Weiser, a leader in research addressing structural barriers to health in vulnerable populations. My mentored research plan will be a vehicle for these training goals and will leverage the infrastructure of the Women's Interagency HIV Study, a multi-site prospective study based in the United States (US) following the largest dedicated cohort of HIV-infected women worldwide and reflecting the age, race, and antiretroviral use profile of the US HIV epidemic among women. My research aims are: (1) To elucidate individual and contextual factors that enable or inhibit DM/HIV co-management; (2) To investigate the impact of a) HIV comorbidity on DM management (primary analysis), and b) DM comorbidity on ART adherence and HIV viral load (secondary analysis), examining the mediating or modifying role of social and economic factors; (3) To evaluate the impact of social and economic factors on DM/HIV co-management; (4) To develop and test the feasibility an intervention to improve DM/HIV co-management, targeting the factors identified in Aims 1-3. By intertwining my training goals with my proposed research, I will lay the groundwork for a long-term research agenda investigating and intervening on social and economic issues affecting DM and HIV comorbidity and co-management. My ultimate goal is to inform policies and programs spanning the clinical and community context to improve chronic disease outcomes for vulnerable populations with HIV.

 描述（由申请人提供）：艾滋病毒流行面临的一个重大挑战是慢性疾病（包括糖尿病（DM）和心血管疾病）的负担日益增加，需要个人同时自我管理多种复杂的疾病。此外，社会和经济脆弱性可能会加剧对糖尿病和艾滋病毒共同管理的障碍。然而，现有证据有限，无法了解个人在共同管理艾滋病毒和糖尿病方面面临的挑战，以及社会和经济脆弱性（例如经济贫困、粮食不安全）影响艾滋病毒/糖尿病共同管理和随后健康结果的具体方式。特别是，感染艾滋病毒的妇女受到社会经济贫困的影响尤为严重，这表明她们在艾滋病毒/糖尿病共同管理方面可能面临更大的结构性障碍。应对这一挑战需要领导者致力于并能够进行跨领域研究，将社会/行为和临床科学以及艾滋病毒和DM特定研究流联系起来。这个K 01指导研究科学家发展奖将建立在我以前的卫生政策培训和以前对艾滋病毒和经济脆弱性的研究，使我能够成为一个独立的调查员解决糖尿病，艾滋病毒和健康的社会决定因素的相互作用。为了实现这一目标，我将获得以下方面的培训和指导：DM的临床和人群健康方面;依从性和疾病自我管理的理论和措施;高级统计方法，包括结构方程模型;以及干预和试验设计。我将得到一个杰出的导师和顾问小组的支持，包括艾滋病毒临床医生，社会和行为研究人员，内分泌学家和统计学家，由Sheri Weiser博士领导，他是解决弱势群体健康结构性障碍的研究领导者。我的指导研究计划将成为这些培训目标的工具，并将利用妇女机构间艾滋病毒研究的基础设施，这是一项位于美国（US）的多地点前瞻性研究，遵循全球最大的艾滋病毒感染妇女队列，反映了美国妇女艾滋病毒流行的年龄，种族和抗逆转录病毒药物使用概况。我的研究目标是：（1）阐明能够或抑制DM/HIV共治的个体和环境因素;（2）调查a）HIV共治对DM管理的影响（主要分析），和B）DM合并症对ART依从性和HIV病毒载量的影响（二次分析），审查社会和经济因素的中介或调整作用;（3）评估社会和经济因素对DM/HIV共同管理的影响;（4）针对目标1-3中确定的因素，制定并测试改善DM/HIV共同管理的干预措施的可行性。通过将我的培训目标与我提出的研究交织在一起，我将为长期研究议程奠定基础，调查和干预影响DM和HIV合并症和共同管理的社会和经济问题。我的最终目标是为跨越临床和社区背景的政策和计划提供信息，以改善艾滋病毒弱势群体的慢性病结局。