A mixed methods study of syndemic factors associated with social support and viral suppression among Black men who have sex with men (MSM) in Florida".

项目摘要 南方与男性发生性关系的黑人男性（MSM）的艾滋病毒新诊断率最高（48%）， 2018年，在所有种族的MSM中，艾滋病毒感染率排名第二（31%）。此外，种族差异 在病毒抑制方面，52%的黑人男男性行为者感染艾滋病毒， 61%的白色男男性接触者。大量的研究已经确定了多种共同发生的心理社会因素 造成艾滋病毒诊断、流行率和结果方面种族差异的结构性因素， 黑人男男性接触者这种组合构成了一种流行病，“2+因素或健康状况的相互作用”， 艾滋病毒在黑人男男性行为者中增加。与此同时，越来越多的证据表明，社会支持是一种影响， 在经历一场综合征的黑人男男性接触者中，病毒抑制的调节剂。到目前为止，还没有研究试图 确定佛罗里达的黑人男男性行为者中感染艾滋病毒的亚群，他们可以从共同的生物行为中受益。 艾滋病毒干预，以改善社会支持和病毒抑制的基础上，他们的共同特点。因此，我们认为， K 01奖的首要目标是为我提供资源、培训、指导和知识 需要审查公共卫生、药物使用和艾滋病毒的交叉性，以及流行病学研究。在这 建议，我将采用解释性序贯混合方法设计，以实现具体的目标， 包括：1）应用潜在类别分析（LCA）识别异质性的共病类别 1b）扩展现有文献，以研究 流行病类别和人口统计学; 2）在评估社会支持的量表上验证流行病类别; 3） 探讨在基线水平和病毒感染一年变化指标上的症状群组间差异 抑制;和4）应用半结构化访谈，以验证和情境化定量研究结果。 这些目标将通过利用现有数据、参与者和资源来实现， NIAAA资助的观察性纵向研究（U24 AA 022002），并采访了20名黑人MSM样本 佛罗里达的艾滋病病毒携带者这个K 01应用程序将建立在我的专业知识在艾滋病毒外展，公共卫生，定性 研究和与药物使用和艾滋病毒有关的临床干预研究，并在以下方面接受过高级培训： 一个黑人男男性接触者的流行病学框架，使用LCA来模拟黑人男男性接触者的流行病学状况，招募 黑人男男性接触者进入生物行为艾滋病毒研究，确定有效的生物行为艾滋病毒干预措施和战略 改善这一人群的社会支持和病毒抑制，并负责任地开展研究。 监督这项培训是一个多元化和跨学科的导师团队，他们每个人都将带来独特的 专业领域和多年的合作：罗伯特库克博士和埃里克Schrimshaw（共同主要导师）和 Drs. Typhanye Dyer，Mattia Prosperi，Michael Marsiske，谢尔顿菲尔兹和妮可恩尼斯（共同导师）。的 我提议的K 01奖将使我成为一名独立的科学家， 一项旨在减少黑人男男性行为者之间艾滋病毒健康差距的研究计划。

Project Abstract Black men who have sex with men (MSM) in the South had the highest rate of new HIV diagnoses (48%) and the 2nd highest rate of HIV prevalence (31%) among MSM of all races in 2018. Furthermore, racial disparities exist in terms of viral suppression, with 52% of Black MSM living with HIV achieving viral suppression compared to 61% of White MSM. An extensive body of research has identified multiple co-occurring psychosocial factors and structural factors that contribute to racial disparities in HIV diagnoses, prevalence, and outcomes among Black MSM. This combination constitutes a syndemic, “the interaction of 2+ factors or health conditions” that increase HIV among Black MSM. At the same time, mounting evidence suggests social support as an effect modifier of viral suppression among Black MSM experiencing a syndemic. To date, no study has sought to identify the subgroups of Black MSM living with HIV in Florida who could benefit from a shared biobehavioral HIV intervention to improve social support and viral suppression based on their shared characteristics. Therefore, the overarching goal of the K01 award is to provide me with the resources, training, mentoring and knowledge needed to examine the intersectionality of public health, substance use and HIV, and syndemic research. In this proposal, I will employ the explanatory sequential mixed method design to accomplish the specific aims which include: 1a) application of latent class analyses (LCA) for the identification of heterogeneous syndemic classes among Black MSM living with HIV; 1b) expansion of existing literature to examine the association between syndemic classes and demographics; 2) validation of syndemic classes on scales assessing social support; 3) exploration of syndemic class group differences on measures of baseline level and one-year change in viral suppression; and 4) application of semi-structured interviews to validate and contextualize quantitative findings. These goals will be accomplished by leveraging existing data, participants, and resources from an ongoing NIAAA-funded observational longitudinal study (U24AA022002) and interviewing a sample of 20 Black MSM living with HIV in Florida. This K01 application will build on my expertise in HIV outreach, public health, qualitative research, and clinical intervention research related to substance use and HIV with advanced training in: applying a syndemic framework to Black MSM, using LCA to model syndemic conditions among Black MSM, recruiting Black MSM into biobehavioral HIV research, identifying effective biobehavioral HIV interventions and strategies to improve social support and viral suppression among this population, and responsible conduct of research. Overseeing this training are a diverse and interdisciplinary team of mentors, each of whom will bring unique areas of expertise and years of collaboration: Drs. Robert Cook and Eric Schrimshaw (co-primary mentors) and Drs. Typhanye Dyer, Mattia Prosperi, Michael Marsiske, Sheldon Fields, and Nicole Ennis (co-mentors). The proposed K01 award will allow me to establish myself as an independent scientist with an interdisciplinary research program aimed at reducing health disparities in HIV among Black MSM.