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.

项目概要/摘要 我们将使用创新的社会流行病学方法来纵向描述影响和 艾滋病毒护理连续体中基于性别的暴力机制，定义了差异化护理的关键组成部分 艾滋病毒护理模式可以缓解这些关系并开发一个平台，以了解创伤和暴力 针对顺性别 (cis) 和跨性别 (trans) 女性的艾滋病毒护理和实践 (TVI-HCP) 干预措施 患有艾滋病毒（WLWH）。新出现的证据表明，COVID-19 大流行导致了 针对独联体和跨性别妇女的社会和结构性暴力，她们承受着不平等的待遇 限制、身体距离和市中心经济造成的影响的份额。感受到的影响 边缘化的顺性别和跨性别女性，包括 WLWH，情况更加严重，短期和长期 顺式和跨式 WLWH 的创伤、暴力、安全和艾滋病毒护理连续结果方面的后果 将需要解决。即使在 COVID-19 危机之前，尽管在计划上取得了重大进展， 在许多环境下，WLWH 在所有全球艾滋病毒目标中与顺性别男性存在差距。虽然 WLWH 造成的社会和结构性暴力的全球发生率高得惊人，但缺乏研究 描述不同类型的暴力影响艾滋病毒护理连续结果的机制， 告知干预目标。此外，尽管有人呼吁采用基于创伤和暴力的护理方法 令人惊讶的是，人们对艾滋病毒护理和实践 (TVI-HCP) 以及 WLWH 的独特需求知之甚少。 方法可以根据艾滋病毒临床实践环境进行定制。在拟议的研究中，我们将利用 加拿大环境中现有的基于社区的顺式和跨式 WLWH 队列（性健康和艾滋病毒/艾滋病： 妇女的纵向需求评估），并重新捕获该群体并将其扩大到该市的 300 名 WLWH 温哥华。这项定量研究将包括调查访谈、创新制图和空间分析、艾滋病毒 疾病监测和保密行政联系，以填补关键研究空白并提供信息 多层次 TVI-HCP 规划的组成部分，通过以下方式优化 HIV 护理连续结果：(1) 前瞻性地描述不同类型的暴力经历之间的关系（人际暴力经历） 情感、身体和性暴力；邻里暴力）和病毒载量抑制失败以及 确定这些关系中需要干预的关键调解者； (2) 前瞻性表征 与病毒载量关系最强的差异化艾滋病毒护理模式的关键组成部分 抑制，扩大我们对 WLWH TVI-HCP 量表的初步开发和验证；和（3） 建立创新的社会流行病学平台，用于通报和评估未来的多层次 基于创伤和暴力的艾滋病毒护理干预措施。在持续的 COVID-19 危机中，同时 由于暴力、创伤和艾滋病毒在北美普遍存在，我们的研究提供了一个前所未有的机会 为差异化的艾滋病毒护理模式提供信息，以优化边缘化女性的艾滋病毒临床结果。