Engagement in Care and Emotional Support in the Context of Interpersonal Trauma among Latino Immigrant Men with HIV: A Mixed-Methods Investigation

建议书摘要 由于移民、艾滋病毒、种族和性少数地位的交叉，拉美裔移民男子携带艾滋病毒 (LIMWH)有高度暴露于人际关系创伤(IT)的风险。它是健康的社会决定因素 对受害者的生物、心理、社会和情绪健康造成不利影响，并与许多 艾滋病毒携带者之间的差距，包括精神疾病和护理参与度低。 拉美裔男性受艾滋病毒的影响不成比例，以及与EIC相关的结果，如保留护理 在拉美裔中，这一比例远远低于美国和国际目标。约37%-43%的拉丁裔新近被诊断为艾滋病毒感染者 移民在移民前、移民期间和移民后面临更高的IT风险，如暴力。拉丁裔 PLWH在精神卫生保健方面的参与度也较低，并面临情绪支持(ES)不足的风险-a 具有保护性的资源，可缓冲IT对社会心理、情感和行为的负面影响。 不幸的是，在LIMWH和保护性心理社会中，人们对IT对EIC的影响知之甚少 在IT环境下影响LIMWH中的EIC的资源。为了更好地理解这些关系 在LIMWH中，这项研究将利用最近的患者健康参与(PHE)模型来描述 EIC涉及的心理和情感过程。这种探索性的顺序混合的目的 方法研究是为了丰富LIMWH在EIC和IT方面的经验，以及 艾滋病毒护理小组可以促进的心理社会资源，以改善EIC和心理社会福祉 目标1a：了解LIMWH(n=20)的经验 它以及影响他们的EIC的心理社会和情感影响。目标1b：了解观点 照顾LIMWH的艾滋病毒护理团队成员(n=15)关于IT和心理社会的影响以及 情绪对这一人群中EIC的影响。目标：2：检查暴露于IT环境中的 在控制个人和人际协变量的情况下，LIMWH(n=100)之间的EIC连续体。目标3： 在控制个体的情况下评估Es与LIMWH间EIC连续体的关联性 和人际关系的协变量。建议的研究将使用半结构定性研究的初步结果 采访LIMWH和巴尔的摩-华盛顿大都会地区的艾滋病毒护理提供者，以告知 评估IT、EIC和ES之间关联的定量调查。定性研究的框架方法 将使用数据分析来确定将包括在调查中的主题和关键心理社会变量以及 使用多变量Logistic回归模型、模型检验和分组分析进行后续分析。这 纳入LIMWH和艾滋病毒提供者的观点的迭代办法将加强 并为LIMWH未来的研究和心理社会干预提供信息，以促进最佳的EIC， 心理健康，以及在结束艾滋病毒流行方面取得的进展。

PROPOSAL SUMMARY Due to intersecting immigration, HIV, racial, and sexual minority statuses Latino immigrant men with HIV (LIMWH) are at risk for high levels of exposure to interpersonal trauma (IT). IT is a social determinant of health adversely impacting victims’ biopsychosocial and emotional health and has been associated with numerous disparities including mental illness and poor engagement in care (EIC) among people living with HIV (PLWH). Latino men are disproportionately impacted by HIV, and EIC-related outcomes such as retention in care among Latinos are well below US and international goals. About 37-43% of Latinos newly diagnosed with HIV are immigrants who face increased risk for IT such as violence before, during, and after migration. Latino PLWH also have low engagement in mental health care and are at risk for low emotional support (ES)—a protective resource shown to buffer the negative psychosocial, emotional, and behavioral impacts of IT. Unfortunately, little is known about the impact of IT on EIC among LIMWH and the protective psychosocial resources that influence EIC among LIMWH in the context of IT. To better understand these relationships among LIMWH, this study will utilize the recent Patient Health Engagement (PHE) model describing psychological and emotional processes involved in EIC. The purpose of this exploratory sequential mixed methods study is to generate a rich understanding of the experiences of LIMWH with EIC and IT and the psychosocial resources that HIV care teams can promote to improve EIC and psychosocial well-being among LIMWH by addressing the following specific aims: Aim 1a: Understand the experiences of LIMWH (n=20) with IT and the psychosocial and emotional influences that impact their EIC. Aim 1b: Understand the perspectives of HIV care team members (n=15) caring for LIMWH regarding the impact of IT and psychosocial and emotional influences on EIC in this population. Aim: 2: Examine the association between exposure to IT on the continuum of EIC among LIMWH (n=100) while controlling for individual and interpersonal covariates. Aim 3: Evaluate the association between ES and the continuum of EIC among LIMWH while controlling for individual and interpersonal covariates. The proposed study will use preliminary results from semi-structured qualitative interviews with LIMWH and HIV care providers from the Baltimore-Washington metro area to inform a quantitative survey assessing the associations between IT, EIC and ES. The Framework method of qualitative data analysis will be used to identify themes and key psychosocial variables to be included in the survey and subsequent analysis using multivariable logistic regression models, model testing, and subgroup analysis. This iterative approach incorporating the perspectives of LIMWH and HIV providers will strengthen the validity of the findings and inform future research and psychosocial interventions among LIMWH to promote optimal EIC, psychosocial wellbeing, and progress towards Ending the HIV Epidemic.