The role of resilience in addressing racial disparities in adverse HIV-related outcomes

项目摘要/摘要 在美国，非裔美国人/黑人(AA)是最不利的种族/民族群体 受艾滋病毒流行的影响。因此，白宫国家艾滋病毒/艾滋病战略的目标之一是 永久性地减少艾滋病毒疾病方面长期存在的健康差距。艾滋病毒诊所就诊率下降， AAs使用次优的抗逆转录病毒疗法(ART)(即启动、修改和坚持)很可能是 与高加索人相比，AAS人群中HIV病毒学应答持续恶化的主要媒介。然而， 尽管制定和实施了针对许多已知的个人一级风险和 尽管存在诊所就诊和使用抗逆转录病毒药物的保护性因素，但仍存在很大的种族差异。持续的差距 可能部分归因于表征高风险邻里环境的不利条件(例如， 社会经济剥夺和暴力)，其中艾滋病毒+AA不成比例地居住在其中。然而，尽管如此， 逆境一些AA表现出韧性(即，在逆境中表现出积极的行为/结果) 这可能对减少持续存在的种族差距至关重要。与风险环境相比，个人， 人际关系和邻里复原力代表着新的、更具可塑性的干预目标 缩小持续存在的差距。不幸的是，也许艾滋病毒文献中对韧性的研究还不够深入。 由于缺乏可靠和有效的艾滋病毒+成人复原力衡量标准，该指标涵盖了所有复原力 组件。这项研究的目标是开发一种可靠和有效的个体测量工具， 人际关系和邻里复原力；记录其心理测量特性；并评估 纵向上看，更高的复原力是否通过以下水平促进艾滋病毒+AA中艾滋病毒阳性结果 风险环境。北卡罗来纳大学CFAR HIV临床队列和UAB 1917诊所登记的HIV+AAs数据 队列将用于拟议的研究。具体地说，本研究的目的是(1)使用高级概念图， 这是一种混合方法方法，以生成捕获所有弹性组件的项目；(2)执行 概念图项目的心理测量学测试，以创建可靠和有效的复原力测量，包括 复原力的所有组成部分；(3a)检查复原力和非复原力个体水平的因素(例如， 酒精/药物使用、精神疾病和医疗保险)可能与艾滋病毒的结果相关(例如， 就诊次数、抗逆转录病毒治疗依从性和病毒学抑制) 环境；以及(3b)评估复原力和非复原力个人因素之间的相互作用，方法是 风险环境的水平。这项研究回应了开发多组件的迫切需要 对艾滋病毒+成人进行复原力测量，并确定复原力是否有助于在 HIV+AAs。我们的重要发现可能会导致新的多层次的开发和实施 与复原力相关的干预措施，以减少艾滋病毒疾病中持续存在的种族差异。

Project Summary/Abstract In the United States (U.S.), African Americans/Blacks (AAs) are the racial/ethnic group most adversely impacted by the HIV epidemic. As such, one of the goals of the White House National HIV/AIDS Strategy is to permanently reduce long-standing health disparities in HIV disease. Lower HIV clinic attendance and suboptimal antiretroviral therapy (ART) use (i.e., initiation, modification, and adherence) by AAs are likely the main mediators of continually worse HIV virologic responses among AAs compared to Caucasians. However, despite the development and implementation of interventions targeting many known individual-level risk and protective factors for clinic attendance and ART use, substantial racial disparities remain. Persistent disparities may be due, in part, to the adverse conditions that characterize the high risk neighborhood environments (e.g., socioeconomic deprivation and violence) in which HIV+ AAs disproportionately reside. However, despite such adversities some AAs demonstrate resilience (i.e., displaying positive behaviors/outcomes despite adversity) which may be critical to reducing persistent racial disparities. Compared to the risk environment, individual, interpersonal, and neighborhood resilience represent novel and more malleable intervention targets for reducing persistent disparities. Unfortunately, resilience remains understudied in the HIV literature, perhaps due to the absence of a reliable and valid resilience measure for HIV+ adults that captures all resilience components. The objective of the proposed research is to develop a reliable and valid measure of individual, interpersonal, and neighborhood resilience; to document its psychometric properties; and to assess longitudinally whether higher resilience facilitates positive HIV outcomes among HIV+ AAs by the level of the risk environment. Data on HIV+ AAs enrolled in the UNC CFAR HIV Clinical Cohort and the UAB 1917 Clinic Cohort will be used for the proposed study. Specifically, this study aims to (1) use advanced concept mapping, which is a mixed methods approach, to generate items that capture all components of resilience; (2) perform psychometric testing of concept mapping items to create a reliable and valid resilience measure that includes all components of resilience; (3a) examine whether resilience and non-resilience individual-level factors (e.g., alcohol/drug use, mental illness, and health insurance) are prospectively associated with HIV outcomes (e.g., clinic attendance, ART adherence, and virologic suppression) by the level of the neighborhood risk environment; and (3b) assess for interactions between resilience and non-resilience individual-level factors by the level of the risk environment. This study responds to the critical need to develop a multi-component resilience measure for HIV+ adults and to establish whether resilience facilitates positive HIV outcomes among HIV+ AAs. Our important findings may lead to the development and implementation of novel multilevel resilience-related interventions to reduce persistent racial disparities in HIV disease.