Social and structural violence and HIV care continuum outcomes: Developing a trauma-informed HIV care intervention among WLWH

社会和结构性暴力以及艾滋病毒护理连续性结果：在 WLWH 中制定创伤知情的艾滋病毒护理干预措施

• 批准号: 10328271
• 负责人: Kathleen Deering
• 金额: $ 46.89万
• 依托单位: UNIVERSITY OF BRITISH COLUMBIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-15 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10328271
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Area; Biological; COVID-19 impact; COVID-19 pandemic; Canada; Caring; Charge; Cities; Clinical; Cognitive; Communities; Complex; Continuity of Patient Care; Country; Cross-Sectional Studies; Data; Databases; Development; Disclosure; Disease; Economics; Emotional; Environment; Epidemiologic Methods; Epidemiology; Failure; Future; Goals; Government; HIV; Health; Health Insurance; Healthcare; High Prevalence; Income; Interpersonal Violence; Intervention; Interview; Link; Location; Mediating; Mediator of activation protein; Medical; Mental Depression; Meta-Analysis; Methods; Modeling; Monitor; Needs Assessment; Neighborhoods; North America; Outcome; Policies; Prevalence; Public Health; Recording of previous events; Research; Research Design; Research Priority; Role; Safety; Science; Self Efficacy; Sexual Health; Shoulder; Site; Social support; Surveys; Testing; Time; Trauma; Validation; Violence; Viral Load result; Woman; base; care outcomes; cis-female; cis-male; cisgender; clinical practice; cohort; epidemiology study; experience; falls; gender disparity; gender-based violence; health assessment; improved; innovation; intimate partner violence; men; novel; prospective; psychological violence; psychosocial; sexual violence; social; social stigma; social structure; syndemic; transgender; transgender women

PROJECT SUMMARY/ABSTRACT We will use innovative social epidemiological methods to longitudinally characterize the impacts and mechanisms of gender-based violence on the HIV care continuum, define key components of differentiated HIV care models that mitigate these relationships and develop a platform for trauma- and violence-informed HIV care and practice (TVI-HCP) interventions, among cisgender (cis) and transgender (trans) women living with HIV (WLWH). Emerging evidence suggests that the COVID-19 pandemic has resulted in heightened social and structural gender-based violence against cis and trans women, who are shouldering an inequitable share of the resulting impact of restrictions, physical distancing and economic downtown. Impacts felt by marginalized cis and trans women, including WLWH, are even more severe and the short- and long-term consequences in terms of trauma, violence, safety and HIV care continuum outcomes of cis and trans WLWH will need to be addressed. Even prior to COVID-19 crisis, despite substantial programmatic advancements, WLWH experienced gaps relative to cisgender men in all global HIV targets in many settings. Although the global prevalence of social and structural violence by WLWH is alarmingly high, there is a lack of research delineating mechanisms through which different types of violence impact HIV care continuum outcomes, to inform intervention targets. Moreover, despite calls to apply a trauma-and violence-informed care approach to HIV care and practice (TVI-HCP) and the unique needs of WLWH, surprisingly little is known about how this approach can be tailored in HIV clinical practice environments. In the proposed study we will leverage an existing community-based cohort of cis and trans WLWH in a Canadian setting (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) and recapture and expand this cohort to 300 WLWH in the City of Vancouver. This quantitative study will include survey interviews, innovative mapping and spatial analyses, HIV disease monitoring, and confidential administrative linkages to fill critical research gaps and inform components of multi-level TVI-HCP programming to optimize HIV care continuum outcomes by: (1) Prospectively characterizing relationships between different types of violence experiences (interpersonal emotional, physical and sexual violence; neighbourhood violence) and viral load suppression failure and identifying critical mediators in these relationships on which to intervene; (2) Prospectively characterizing the key components of differentiated HIV care models that have the strongest associations with viral load suppression, expanding on our preliminary development and validation of a TVI-HCP Scale for WLWH; and (3) Establishing an innovative social epidemiological platform for informing and evaluating future multi-level trauma- and violence-informed HIV care interventions. Amidst the ongoing COVID-19 crisis, in parallel with a syndemic of violence, trauma and HIV in North America, our study offers an unprecedented opportunity to inform differentiated HIV care models to optimize HIV clinical outcomes among marginalized women.

项目摘要/摘要 我们将使用创新的社会流行病学方法来纵向表征影响和 基于性别的暴力在艾滋病毒护理连续体中的机制，定义了差异化的关键组成部分 艾滋病毒护理模型减轻这些关系并为受创伤和暴力信息开发平台 艾滋病毒护理和实践（TVI-HCP）干预措施（cis）和跨性别者（跨性别）妇女生活 与艾滋病毒（WLWH）。新兴的证据表明，共证于19号大流行导致增长 基于社会和结构性的基于性别的暴力对独联体和跨性别妇女，她们肩负着不平等的 限制，物理距离和市区经济的影响的份额。影响的影响 边缘化的顺式和包括WLWH在内的跨性别妇女更加严重，短期和长期 在创伤，暴力，安全和艾滋病毒护理连续性结果方面的后果 将需要解决。即使在Covid-19危机之前，尽管有很大的程序化进步， 在许多情况下，WLWH在所有全球艾滋病毒目标中都经历了与cisgender男性的差距。虽然 WLWH对社会和结构性暴力行为的全球流行令人震惊，缺乏研究 描述不同类型的暴力影响艾滋病毒护理连续性结果的机制， 告知干预目标。此外，尽管呼吁采用创伤和暴力的护理方法 HIV护理和实践（TVI-HCP）以及WLWH的独特需求，令人惊讶 方法可以在HIV临床实践环境中量身定制。在拟议的研究中，我们将利用 在加拿大环境中（性健康和艾滋病毒/艾滋病）中现有的基于社区的CIS和Trans WLWH队列： 妇女的纵向需求评估）并重新捕获并将此队列扩展到300 wlwh 温哥华。这项定量研究将包括调查访谈，创新映射和空间分析，艾滋病毒 疾病监测和机密行政联系以填补关键的研究空白并告知 多层TVI-HCP编程的组件，以优化HIV护理连续性结果：（1） 前瞻性地表征不同类型的暴力经历之间的关系（人际关系 情绪，身体和性暴力；邻里暴力）和病毒负荷抑制失败和 在这些关系中识别重要的调解人； （2）前瞻性表征 与病毒负荷有最强关联的分化HIV护理模型的关键组成部分 抑制，扩大了我们对WLWH的TVI-HCP量表的初步发展和验证； （3） 建立创新的社会流行病学平台，用于告知和评估未来的多层次 创伤和暴力的艾滋病毒护理干预措施。在正在进行的Covid-19危机中，与 我们的研究为北美的暴力，创伤和艾滋病毒的集合，为前所未有的机会提供 告知差异化的艾滋病毒护理模型，以优化边缘化妇女中的艾滋病毒临床结果。