Barriers to Care & Treatment Practices in HIV+ Latinos in US-Mexico Border Region

描述（由申请人提供）：我们以社区为基础的参与性研究的目标是确定美国-墨西哥边境地区艾滋病毒阳性拉丁美洲人接受艾滋病毒护理的障碍。加州是拉美裔艾滋病病例最多的五个州之一，拉美裔占圣地亚哥县南部地区报告的艾滋病病例的66%。拉丁美洲人在艾滋病毒护理方面面临重大障碍，并且在艾滋病毒疾病晚期才进入护理，但其原因知之甚少，可能涉及与污名化、对艾滋病毒治疗持乐观态度以及使用传统、补充和/或替代药物（CAM）有关的问题。我们将评估美国-墨西哥边境地区拉丁美洲人的艾滋病毒护理和护理实践障碍，应用Andersen & day的健康服务行为模型作为我们的概念框架来研究环境，结构，行为和社会因素。我们建议以社区为基础的两国合作研究，以现有的学术社区伙伴关系为基础，采用定量和定性方法来实现目标。目标1：评估目前居住在墨西哥下加利福尼亚州蒂华纳或加利福尼亚州圣地亚哥的艾滋病毒阳性拉丁美洲人中寻求两国卫生保健的行为和艾滋病毒治疗的利用情况，包括获得抗逆转录病毒药物和使用CAM（例如民间药物、草药）。目标2：确定获得艾滋病毒护理的具体障碍，包括居住在蒂华纳和圣地亚哥的艾滋病毒阳性拉丁美洲人中与艾滋病毒相关的污名、流动性和灵性/宗教信仰的表现。目的3：探讨在美国-墨西哥边境两侧的卫生保健提供背景下，艾滋病毒阳性拉丁美洲人的艾滋病毒护理和接受抗逆转录病毒药物的连续性的提供者和系统层面的障碍。为了实现目标1和目标2，我们将开展一项定量研究，该研究基于采访者对200名艾滋病毒阳性人员进行的调查（100名参与者从边境两侧招募）。我们将使用描述性和多元逻辑回归统计分析来检验特定的假设。为了实现目标3，我们将有目的地对20名提供者/管理人员进行抽样调查，对患者在艾滋病毒护理方面的障碍进行深入访谈。根据扎根理论方法，数据收集和分析将包括使用持续比较方法开发和修订访谈指南。调查小组将独立编码并就访谈编码达成共识，以反映影响卫生服务的主题/问题、行为描述以及对组织/系统特征的意见。本研究将通过提高对艾滋病毒求诊行为的理解，减少艾滋病毒阳性拉丁裔人的健康差异；艾滋病毒护理做法}，包括CAM的使用；制定以社区为基础和与文化有关的研究方法和措施；并推进努力，积极影响生活在美墨边境地区的拉丁美洲人和其他感染艾滋病毒/艾滋病的美国拉丁裔人口的护理服务。公共卫生相关性我们以社区为基础的参与性研究的目的是确定美国-墨西哥边境地区艾滋病毒阳性拉丁美洲人接受艾滋病毒护理的障碍。拉丁美洲人在艾滋病毒护理方面面临重大障碍，并且在艾滋病毒疾病晚期才进入护理，但其原因知之甚少，可能涉及与污名化、对艾滋病毒治疗持乐观态度以及使用传统、补充和/或替代药物（CAM）有关的问题。拟议的研究将评估美国-墨西哥边境地区艾滋病毒阳性拉丁美洲人的艾滋病毒护理和护理实践障碍，应用Andersen & day的健康服务行为模型作为我们的概念框架来研究环境，结构，行为和社会因素。

DESCRIPTION (provided by applicant): The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. California ranks among the top five states with highest numbers of Latino AIDS cases and Latinos comprise 66% of reported HIV cases in San Diego County's southern region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). We will assess barriers to HIV care and care practices among Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors. We propose a community-based binational collaborative study that builds on existing academic-community partnerships and employs quantitative and qualitative methods to address aims. Aim 1: To assess binational health care seeking behavior and HIV treatment utilization, including access to ARVs and use of CAM (e.g. folk medicine, herbal medicine) among HIV-positive Latinos who currently reside in Tijuana, Baja California, Mexico or San Diego, CA. Aim 2: To determine specific barriers to HIV care, including manifestations of HIV-related stigma, mobility and spirituality/religiosity among HIV-positive Latinos who reside in Tijuana and San Diego. Aim 3: To explore provider and system-level barriers to continuity of HIV care and receipt of ARVs in HIV-positive Latinos within the health care delivery context of both sides of the US- Mexico border. To address Aims 1 and 2 we will conduct a quantitative study, based on interviewer- administered surveys with 200 HIV-positive persons (100 participants recruited from both sides of border). We will use descriptive and multivariate logistic regression statistical analyses to test specific hypotheses. To meet Aim 3, we will purposively sample 20 providers/administrators, conducting in-depth interviews on experiences with patient barriers to HIV care. Following Grounded Theory methods, data collection and analysis will include development and revision of interview guides using constant comparison method. The investigator team will independently code and reach consensus on interview coding to reflect themes/issues, accounts of behaviors, and opinions on organizational/system characteristics that influence health services. This study will decrease health disparities in HIV-positive Latinos through improved understanding of HIV care-seeking behavior; HIV care practices}including CAM use; development of community-based and culturally-relevant research methods and measures; and advancing efforts to positively impact care delivery in Latinos living in the US- Mexico border region and in other US Latino populations living with HIV/AIDS. PUBLIC HEALTH RELEVANCE The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). The proposed study will assess barriers to HIV care and care practices among HIV-positive Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors.