Effects of trauma on retention in HIV care and durable viral suppression among African American men and women

项目总结 艾滋病毒携带者(PWH)经历过人际关系创伤的可能性是他们的两到五倍 寿命比一般人口多1-3岁。人际关系创伤(儿童期身体虐待、儿童期性虐待 [复杂创伤]、成人身体和性侵犯以及亲密伴侣暴力[IPV/成年伴侣虐待]) 负面影响治疗依从性、护理保留、病毒抑制4-9和艾滋病毒传播4，39 非裔美国人(A.A.)承担不成比例的艾滋病毒和创伤负担2，10-12，39-40。艾滋病毒传播率 感染艾滋病毒的男性和女性的健康结果不同，这种差异可能与他们的 创伤经验13-15。创伤对戒酒会男性和女性保留艾滋病毒护理的影响，也就是说， 遵守常规的医疗预约和持久的病毒抑制，还没有得到很好的理解。长- 在艾滋病毒护理中长期保留对于预防艾滋病毒疾病进展、改善治疗依从性和 抑制病毒载量，增加积极的临床健康结果，减少艾滋病毒传播和 死亡4.以前的研究表明，携带艾滋病毒的戒毒者在艾滋病护理中的长期保留只是 在开始艾滋病毒护理的36个月时为46%，而在非黑人参与者中为63%。结果还包括 在艾滋病患者中，在持久病毒抑制方面存在种族差异，从12岁开始 自艾滋病毒护理开始以来的几个月和以后，增加了艾滋病毒传播的潜在风险24，33。A.A. 占美国近120万PWH患者的40%(479,300人)，占近36,801例新诊断HIV患者的42% 在美国，虽然只占美国人口的13%，但39-40岁。戒酒会女性的临床症状最差 健康结果11，12和比所有种族和民族更多的创伤经历10-12 经历创伤的几率比感染艾滋病毒的女性低；然而，她们经历的创伤比艾滋病毒更多。 消极的男人2。到目前为止，大多数研究都使用横断面设计来检查两者之间的关系 保留艾滋病毒护理、病毒抑制和创伤经历仅提供单个 时间瞬间12，18.需要进行纵向研究才能更深入地了解长期临床 创伤在艾滋病患者中保留艾滋病毒护理和持久病毒抑制中的意义。这个 这一F31奖学金的目的是名为Mirrors(创伤和艾滋病毒：保留在艾滋病毒护理和病毒治疗中 压载救人)，是进行二次分析检验相对贡献率 每种类型的人际创伤和经历过的创伤(童年、成年)对生活阶段的影响 在超过24个月的艾滋病毒携带者中，在艾滋病毒护理和持久的病毒抑制方面。这个 拟议的研究将利用来自R01 MH092286的数据集《健康素养对健康差距的影响》 HIV临床结果“(P.I.：WalDrop)--一项对700名男性和女性进行的纵向研究 (n=424名黑人/非裔美国人)艾滋病毒携带者；并使用父项目的辅助研究 护理和健康素养“(丰富)(F31-NR017580：PI.A.安德森)。

PROJECT SUMMARY People with HIV (PWH) are two to five times more likely to have experienced interpersonal trauma in their lifetime than the general population1-3. Interpersonal trauma (childhood physical abuse, childhood sexual abuse [complex trauma], adult physical and sexual assault, and intimate partner violence [IPV/Adult Partner Abuse]) negatively impacts treatment adherence, retention in care, and viral suppression4-9 and HIV transmission4,39 African Americans (A.A.) bear a disproportionate burden of HIV and trauma2,10-12,39-40. HIV transmission rates and health outcomes differ for men and women with HIV, a difference that may be associated with their experience of trauma13-15. The impact of trauma for A.A. men and women on retention in HIV care, that is, keeping routine medical appointments and durable viral suppression, is not well understood. Long- term retention in HIV care is critical in preventing HIV disease progression, improving treatment adherence and viral load suppression, increasing positive clinical health outcomes and reducing HIV transmission and mortality4. Previous research showed that long-term retention in HIV care among A.A. living with HIV was only 46% at 36 months since the start of HIV care compared to 63% in the nonblack participants4. Results also showed racial disparities in durable viral suppression among A.A. men and women with HIV 4,16 begin at 12 months since the start of HIV care and beyond, increasing the potential risk of HIV transmission 24,33. A.A. account for 40% (479,300) of nearly 1.2 million PWH in the U.S., and 42% of nearly 36,801 new HIV diagnoses in the U.S., while only representing 13% of the U.S. population39-40. A.A. women have the poorest clinical health outcomes11,12 and greater experience of trauma than all races and ethnicities 10-12,17. HIV-positive men experience lower rates of trauma than women with HIV; however, they experience more trauma than HIV- negative men2. Thus far, most studies have used a cross-sectional design to examine relationships between retention in HIV care, viral suppression4, and trauma experiences providing only a snapshot of a single moment in time 12,18. Longitudinal studies are needed for a deeper understanding of the long-term clinical implications of trauma in retention in HIV care and durable viral suppression among the A.A. PWH. The purpose of this F31 fellowship, entitled MIRRORS (TRAUMA & HIV: RETENTION in HIV CARE and VIRAL LOAD SUPPRESSION SAVES LIVES), is to conduct a secondary analysis testing the relative contribution of each type of interpersonal trauma and life stages with experienced trauma (childhood, adulthood) on retention in HIV care and durable viral suppression among A.A. men and women with HIV over 24 months. The proposed study will utilize datasets from R01 MH092286 “Effects of Health Literacy on Health Disparities in HIV Clinical Outcomes” (P.I.: Waldrop), a completed longitudinal study among 700 men and women (n=424 Black/African American) with HIV; and use the parent project’s ancillary study, “Examining Retention in Care and Health Literacy” (ENRICH) (F31- NR017580: PI. A. Anderson).