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

描述(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美人在艾滋病毒护理方面的障碍。加利福尼亚州是拉美裔艾滋病病例最多的五个州之一，在圣地亚哥县南部地区报告的艾滋病毒病例中，拉美裔占66%。拉美裔人在艾滋病毒护理方面面临巨大障碍，并在艾滋病毒疾病晚期进入护理阶段，但原因尚不清楚，可能涉及与污名、艾滋病毒治疗乐观和使用传统、补充和/或替代药物(CAM)有关的问题。我们将使用Andersen&Aday的卫生服务行为模型作为我们研究环境、结构、行为和社会因素的概念框架，评估美国-墨西哥边境地区拉美裔人在艾滋病毒护理和护理实践中遇到的障碍。我们提出了一个以社区为基础的两国合作研究，建立在现有的学术和社区伙伴关系的基础上，并采用定量和定性的方法来解决目标。目标1：评估目前居住在墨西哥提华纳、下加利福尼亚州、墨西哥或加利福尼亚州圣地亚哥的艾滋病毒阳性拉美裔人的两国卫生保健寻求行为和艾滋病毒治疗利用情况，包括获得抗逆转录病毒药物和使用CAM(如民间药物、草药)的情况。目标2：确定艾滋病毒护理的具体障碍，包括居住在提华纳和圣地亚哥的艾滋病毒阳性拉美裔人与艾滋病毒有关的污名、流动性和灵性/宗教信仰的表现。目标3：在美墨边境两侧的卫生保健提供背景下，探索在艾滋病毒阳性拉美人中持续提供艾滋病毒护理和接受抗逆转录病毒药物的提供者和系统一级的障碍。为了实现目标1和目标2，我们将根据面试者对200名艾滋病毒阳性者(从边境两侧招募的100名参与者)进行的调查，进行一项量化研究。我们将使用描述性和多元Logistic回归统计分析来检验特定的假设。为了达到目标3，我们将有目的地抽样20名提供者/管理人员，就患者在艾滋病毒护理方面的障碍进行深入访谈。根据扎根的理论方法，数据收集和分析将包括使用不断比较的方法开发和修订面试指南。调查员团队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、行为描述和对组织/系统特征的意见。这项研究将通过提高对艾滋病毒寻求护理行为的了解、艾滋病毒护理实践(包括使用CAM)、开发基于社区和文化相关的研究方法和措施，以及进一步努力积极影响生活在美墨边境地区的拉美裔人和其他感染艾滋病毒/艾滋病的美国拉丁裔人的护理提供，来减少艾滋病毒阳性拉美裔人的健康差距。公共卫生相关性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美裔人在艾滋病毒护理方面的障碍。拉美裔人在艾滋病毒护理方面面临巨大障碍，并在艾滋病毒疾病晚期进入护理阶段，但原因尚不清楚，可能涉及与污名、艾滋病毒治疗乐观和使用传统、补充和/或替代药物(CAM)有关的问题。这项拟议的研究将使用Andersen&Aday的卫生服务行为模型作为我们研究环境、结构、行为和社会因素的概念框架，评估美国-墨西哥边境地区艾滋病毒阳性拉美裔人在艾滋病毒护理和护理实践中遇到的障碍。

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.