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

HIV 披露对临床结果影响的机制：一项纵向研究

• 批准号: 9138465
• 负责人: Shan Qiao
• 金额: $ 20.54万
• 依托单位: UNIVERSITY OF SOUTH CAROLINA AT COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-04-01 至 2018-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9138465
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; Age; Anti-Retroviral Agents; Anxiety; Area; Behavior; Behavioral; Behavioral Mechanisms; Biological; Biological Factors; Biological Markers; CD4 Lymphocyte Count; Caring; Child; China; Chronic stress; Clinical; Clinical Data; Collaborations; Communities; Continuity of Patient Care; Data; Development; Diagnosis; Disclosure; Discrimination; Disease; Disease Progression; Epidemic; Event; Family; Family member; Funding; Future; Gender; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Hair; Health; Human; Hydrocortisone; Improve Access; Intervention; Intervention Studies; Interview; Knowledge; Life; Link; Literature; Long-Term Effects; Longitudinal Studies; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Methodology; Methods; Nature; Neurosecretory Systems; Outcome; Pathway interactions; Patient Self-Report; Pattern; Pharmaceutical Preparations; Prevention; Process; Psychological Stress; Research; Research Infrastructure; Research Methodology; Risk Reduction; Self Disclosure; Skin; Social Environment; Social support; Societies; Staging; Testing; United States National Institutes of Health; Viral Load result; base; clinical care; cohort; combat; coping; design; emotional disclosure; experience; follow-up; immune function; improved; low and middle-income countries; medication compliance; novel marker; physical conditioning; psychologic; psychological distress; psychosocial; public health relevance; response; seropositive; social; social stigma; targeted delivery

 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.

 描述（由申请人提供）：在抗击艾滋病毒流行的三十多年里，自2001年以来，全球新的艾滋病毒感染减少了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，特别是对中低收入国家的艾滋病毒/艾滋病感染者而言。艾滋病毒披露（自我披露艾滋病毒血清阳性状态）是艾滋病毒治疗和护理连续性的关键步骤，对艾滋病毒感染者和社会都有潜在的好处。披露是一个逐步（跨越不同阶段）和有选择地（有各种目标）提供嵌入社会背景和社会关系的信息的过程。在实践中，根据社会关系的性质，有各种类型的披露。在本申请中，艾滋病毒披露是指艾滋病毒携带者向其他人，包括伴侣、儿童、家庭成员和重要的其他人（即，一般披露）。全球文献表明，披露可能有助于艾滋病毒感染者积极应对艾滋病毒/艾滋病，加强社会支持，改善获得医疗保健，促进药物治疗的坚持，增加机会，讨论和实施艾滋病毒风险降低，并减少心理压力。然而，我们对艾滋病毒披露是否会影响临床结果的了解有限（例如，CD 4计数、病毒载量、疾病进展）。也有一个缺乏经验数据的潜在机制的影响，艾滋病毒的披露对临床结果，以及内在的，人际的，和社会因素，可能潜在的温和或调解披露对临床结果的影响。最近的研究，包括我们自己的初步数据，提出了两个潜在的途径：生物途径（例如，影响对慢性应激的神经内分泌和交感神经反应）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学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是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。在本申请中，我们建议通过最近被诊断为HIV阳性的400人的纵向队列（即，自2004年以来，我们通过NIH资助的研究，在中国广西建立了强大的研究基础设施和社区合作。主要措施包括艾滋病毒的披露模式，其特点是披露阶段，慢性压力，坚持艾滋病毒治疗和护理，和临床结果（CD 4计数，病毒载量和疾病进展）。除了自我报告的数据（例如，抑郁和焦虑、药物依从性）、慢性应激的生物标志物（毛发皮质醇）和药物依从性（毛发抗逆转录病毒浓度）。本申请解决了调查积极的心理社会/行为因素（例如，艾滋病毒披露）可能会“深入皮肤”，影响身体健康，从而拓宽了我们审查艾滋病毒披露影响的研究视角。它还通过明确评估HIV披露对新型生物标志物临床结果影响的两个动态途径，扩展了HIV披露研究的现有概念和方法。拟议的研究意义重大，因为它解决了艾滋病毒治疗和护理中的一个关键问题。经验数据和研究结果将有助于我们的知识基础，并告知未来的艾滋病毒披露干预工作的基础上，披露如何影响身体健康的PLWH之间的动态过程的综合数据。