Co-occurring factors that heighten transgender women's vulnerability to suboptimal ART adherence in India

导致印度变性女性接受辅助生殖技术依从性不佳的同时发生的因素

基本信息

批准号：
10481442
负责人：
William Lodge
金额：
$ 5.48万
依托单位：
BROWN UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10481442
关键词：
AIDS prevention Address Adherence Advocacy Affect Alcohol consumption Anus Award Buffers Caring Cities Clinic Clinical Clinical Services Collaborations Continuity of Patient Care Coping Skills Data Discrimination Drug usage Emotional Environment Face Family Funding Future Gender Identity Goals Grant HIV Health Professional Healthcare Healthcare Systems India Individual Intervention Interview Location Mental Depression Mentors Morbidity - disease rate Outcome Patient Self-Report Pattern Persons Plasma Poverty Prevalence Publishing Research Risk Role Services Sexual Partners Sexual Transmission Sexual and Gender Minorities Site Social Work Social support Testing Transportation Trust United States National Institutes of Health Vagina Victimization Viral Viral Load result Work antiretroviral therapy base care outcomes care systems cultural competence design effective intervention experience gender minority health group intervention high risk high risk population housing instability improved informant men who have sex with men mortality multilevel analysis outreach peer pilot test preference prevention service programs psychosocial research study resilience service providers sex sexual risk behavior social stigma substance use substance use treatment syndemic therapy adherence transgender transgender women treatment program

项目摘要

SUMMARY Background: In India, HIV prevalence is highest among transgender women (TGW) or Hijras. Although HIV can be managed with ongoing antiretroviral therapy (ART), achieving maximal benefit necessitates engagement with the healthcare system and requires excellent adherence, which has shown to be challenging in India despite ART being free. Studies have shown that TGW in India experience high rates of individual (e.g., drug and alcohol use, depression), interpersonal (e.g., victimization, discrimination), and structural (e.g., poverty, housing instability, clinic access) challenges. While limited evidence suggests that these co-occurring syndemic factors are associated with suboptimal adherence and viral suppression among TGW in other settings, little is known about whether and how these factors influence ART adherence and viral suppression among TGW in India. Moreover, while TGW experience high rates of discrimination and familial rejection based on their gender identity, which may be compounded for TGW living with HIV, many TGW in India counteract this familial and societal rejection by forming their own family units comprised of other TGW. Based on research in other settings, this social support might buffer the detrimental effect syndemic factors may have on ART adherence. Environment: We will leverage an established, 16-year research collaboration between the PI’s mentors and Humsafar Trust (HST), the largest NGO focused on sexual and gender minority health in India – with research sites in both Mumbai and New Delhi, India's two biggest cities with 12.5 and 16.8 million people, respectively. Approach: The study aims to understand patterns and high-risk groups underlying suboptimal ART adherence and unsuppressed viral load related to substance use, stigma, and other syndemic factors among TGW in Mumbai and New Delhi, India and to assess potential buffering mechanisms for future intervention targets. To this end, we propose to: (1) conduct qualitative interviews with TGW (n=30) and clinical and social service providers (n=10) to assess the individual, interpersonal and structural level syndemic factors impacting ART adherence and unsuppressed viral load; and (2) to characterize patterns of multilevel syndemic factors and identify high-risk profiles of 150 TGW living with HIV in Mumbai and New Delhi. We will conduct a quantitative assessment and use Latent Class Analysis (LCA) to determine the patterns of the multilevel barriers that arise in Aim 1, and fit a multilevel model to better understand the relationships between the identified syndemic classes and unsuppressed viral load (via plasma viral load testing) and ART adherence (via self-report). Findings from this R36 doctoral dissertation award will provide preliminary data, using qualitative and LCA syndemic risk profiles, to support the submission of a larger NIH grant to design and pilot test an adaptive, multi-component (e.g., possibly including substance use treatment, resilience coping, skill-building) intervention to improve HIV care continuum outcomes among TGW living with HIV in India.

概括背景：在印度，跨性别女性 (TGW) 或海吉拉人中的艾滋病毒感染率最高，尽管艾滋病毒可以。通过持续的抗逆转录病毒治疗（ART）进行管理，要实现最大效益，就需要参与医疗保健系统需要良好的依从性，尽管如此，这在印度已被证明具有挑战性 ART 是免费的。研究表明，印度的 TGW 中个人（例如吸毒和酗酒）的比例很高。使用、抑郁）、人际（例如受害、歧视）和结构（例如贫困、住房）虽然有限的证据表明这些同时发生的综合症因素。与其他环境中 TGW 的次佳依从性和病毒抑制有关，但目前所知甚少关于这些因素是否以及如何影响印度 TGW 的 ART 依从性和病毒抑制。此外，虽然 TGW 因性别而遭受歧视和家庭排斥的比例很高对于感染艾滋病毒的 TGW 来说，身份可能会变得更加复杂，印度的许多 TGW 抵消了这种家族性和根据其他环境的研究，通过组建由其他 TGW 组成的自己的家庭单位来受到社会排斥。这种社会支持可能会缓冲综合症因素可能对 ART 依从性产生的不利影响。环境：我们将利用 PI 导师和 PI 导师之间已建立的 16 年研究合作关系 Humsafar Trust (HST) 是印度最大的专注于性和性别少数群体健康的非政府组织 – 开展研究分别位于印度最大的两个城市孟买和新德里，人口分别为 12.5 和 1680 万，方法：该研究旨在了解次优 ART 背后的模式和高风险群体与物质使用、耻辱和其他综合症因素相关的依从性和未抑制的病毒载量 TGW 位于印度孟买和新德里，评估未来干预的潜在缓冲机制为此，我们建议：（1）对 TGW（n=30）以及临床和社会进行定性访谈。服务提供者（n=10）评估影响个体、人际和结构层面的综合症因素 ART 依从性和未抑制的病毒载量；以及 (2) 表征多级流行病因素的模式和我们将在孟买和新德里确定 150 名艾滋病毒感染者的高风险概况。评估并使用潜在类别分析 (LCA) 来确定出现的多级障碍的模式在目标 1 中，拟合多级模型以更好地理解已识别的综合征类别之间的关系未抑制的病毒载量（通过血浆病毒载量测试）和 ART 依从性（通过自我报告的结果）。该 R36 博士论文奖将使用定性和 LCA 综合征风险提供初步数据配置文件，以支持提交更大的 NIH 拨款来设计和试点测试适应性、多组件（例如，可能包括药物滥用治疗、复原力应对、技能建设）改善艾滋病毒的干预措施印度艾滋病毒感染者 TGW 的护理连续结果。