Mechanisms of the effect of HIV disclosure on clinical outcomes: A longitudinal study

 描述(申请人提供)：经过三十多年的抗击艾滋病毒疫情，自2001年以来，全球新的艾滋病毒感染人数下降了38%。尽管如此，艾滋病毒仍然是人类面临的最严重的健康和发展挑战之一，特别是对低收入和中等收入国家的艾滋病毒/艾滋病感染者来说。艾滋病毒披露(艾滋病毒血清阳性状态的自我披露)是艾滋病毒治疗和护理连续不断的关键步骤，对PLWH和社会都有潜在的好处。披露是一个逐步(跨越不同阶段)和选择性(具有不同目标)传递嵌入社会背景和社会关系的信息的过程。根据社会关系的性质，在实践中有各种类型的披露。在本申请中，艾滋病毒披露是指公共卫生部门向包括伴侣、儿童、家庭成员和重要其他人在内的其他人披露其艾滋病毒阳性状态的过程(即一般披露)。全球文献表明，披露信息可能会通过加强社会支持、改善获得医疗护理的机会、促进服药依从性、增加讨论和实施减少艾滋病毒风险的机会以及减少心理压力，来促进公共卫生部门积极应对艾滋病毒/艾滋病。然而，我们对HIV的披露是否会影响PLWH中的临床结果(例如，CD4计数、病毒载量、疾病进展)的了解有限。关于HIV披露对临床结果的影响的潜在机制，以及可能缓和或调节披露对临床结果的影响的个人、人际和社会因素，也缺乏经验数据。最近的研究，包括我们自己的初步数据，已经提出了两种可能的途径：生物途径(例如，影响神经内分泌和交感神经对慢性应激的反应)和行为途径(例如，影响对药物依从性至关重要的行为)。可能的生物学和行为机制在很大程度上是假设的，但没有在纵向研究中进行实证检验。此外，现有的艾滋病毒披露研究大多基于自我报告或定性调查的数据，而不是客观的生物医学措施。在目前的申请中，我们建议通过对广西中国400名最近被诊断为艾滋病毒阳性的人(即自2014年1月以来被诊断为艾滋病毒感染的人)的纵向队列来检验艾滋病毒披露对临床结果的长期影响。自2004年以来，我们通过国家卫生研究院资助的研究建立了强大的研究基础设施和社区合作。主要措施包括以披露阶段、慢性压力、坚持艾滋病毒治疗和护理以及临床结果(CD4计数、病毒载量和疾病进展)为特征的艾滋病毒披露模式。除了自我报告的数据(例如，抑郁和焦虑、服药依从性)，还将使用慢性压力(头发皮质醇)和服药依从性(头发抗逆转录病毒浓度)的生物标记物。目前的申请涉及调查积极的心理/行为因素(例如，艾滋病毒披露)如何“深入”影响身体健康的重要性，从而拓宽了我们审查艾滋病毒披露的影响的研究视角。它还通过使用新的生物标记物明确评估艾滋病毒披露对临床结果的影响的两条动态路径，扩展了现有的艾滋病毒披露研究的概念和方法。这项拟议的研究具有重要意义，因为它解决了艾滋病毒治疗和护理中的一个关键问题。经验数据和发现将有助于我们的知识库，并基于关于披露如何影响公共卫生人员身体健康的动态过程的全面数据，为未来的艾滋病毒披露干预工作提供信息。

 DESCRIPTION (provided by applicant): With over three-decades of combating the HIV epidemic, new HIV infections have decreased by 38% globally since 2001. Still, HIV is one of most serious health and developmental challenges for human beings, particularly for people living with HIV/AIDS (PLWH) in low- and middle-income countries (LMIC). HIV disclosure (self-disclosure of HIV seropositive status) is a critical step of HIV treatment and care continuum with potential benefits for both PLWH and society. Disclosure is a process of gradual (across different stages) and selective (with various targets) delivery of information embedded in social context and social relationships. There are various types of disclosure in practice depending on the natures of social relationships. In this application, HIV disclosure refers to a process in which PLWH disclose their HIV positive status to others including partners, children, family members, and significant others (i.e., general disclosure). Global literature suggests that disclosure may facilitate PLWH's actively coping with HIV/AIDS by enhancing social support, improving access to medical care, promoting medication adherence, increasing opportunities to discuss and implement HIV risk reduction, and reducing psychological stress. However, we have limited understanding on whether HIV disclosure will affect clinical outcomes (e.g., CD4 count, viral load, disease progression) among PLWH. There is also a dearth of empirical data regarding potential mechanisms underlying the effects of HIV disclosure on clinical outcomes, as well as intrapersonal, interpersonal, and social factors that may potentially moderate or mediate the effects of disclosure on clinical outcomes. Recent research, including our own preliminary data, has suggested two potential pathways: biological pathway (e.g., affecting the neuroendocrine and sympathetic nervous response to chronic stress) and behavioral pathway (e.g., affecting the behaviors that are crucial to medication adherence). The possible biological and behavioral mechanisms have been largely hypothesized, but not empirically tested in longitudinal studies. In addition, existing HIV disclosure research is mostly based on data through self-report or qualitative inquiries rather than objective biomedical measures. In the current application, we propose to examine long-term effects of HIV disclosure on clinical outcomes through a longitudinal cohort of 400 people recently diagnosed as HIV positive (i.e., people who have been diagnosed with HIV infection since January 2014) in Guangxi China where we have built a strong research infrastructure and community collaboration through NIH-funded research since 2004. The primary measures include HIV disclosure patterns characterized by disclosure stages, chronic stress, adherence to HIV treatment and care, and clinical outcomes (CD4 count, viral load, and disease progression). In addition to self-reported data (e.g., depression and anxiety, medication adherence), biomarkers of chronic stress (hair cortisol) and medication adherence (hair antiretroviral concentration) will be employed. The current application addresses the importance of investigating how positive psychosocial/behavioral factor (e.g., HIV disclosure) may "get under the skin" to influence physical health and thus broadens the research perspective in which we review the effects of HIV disclosure. It also expands existing conceptualization and methodology on HIV disclosure research by explicitly assessing two dynamic pathways of the effects of HIV disclosure on clinical outcomes with novel biomarkers. The proposed research is significant as it addresses a critical issue in HIV treatment and care. The empirical data and findings will contribute to our knowledge base and inform future HIV disclosure intervention efforts based on comprehensive data of the dynamic process of how disclosure influences physical health among PLWH.