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

• 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
• 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

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，跨性别妇女（TGW）或hijras中的艾滋病毒患病率最高。虽然艾滋病毒可以 通过正在进行的抗逆转录病毒疗法（ART）进行管理，从而获得最大的收益 医疗保健系统需要出色的依从性，这在印度目的地表明具有挑战性 艺术是自由的。研究表明，印度的TGW经历了很高的个体率（例如毒品和酒精 使用，抑郁），人际关系（例如欺诈，歧视）和结构性（例如贫困，住房 不稳定性，诊所通道）挑战。虽然有限的证据表明这些同时发生的联合因素 与其他环境中TGW之间的次优依从性和病毒抑制有关，鲜为人知 关于这些因素是否以及如何影响印度TGW的艺术依从性和病毒抑制。 此外，尽管TGW根据性别经历了高歧视和家庭​​拒绝的速度 身份可能会使TGW患有艾滋病毒的TGW更加复杂，印度许多TGW抵消了这个家庭和 通过组建自己的家庭单位完成的社会拒绝，完成了其他TGW。基于其他环境的研究， 这种社会支持可能会缓解辛迪克血症因素可能对艺术依从性产生的有害影响。 环境：我们将利用PI的导师与 Humsafar Trust（HST）是印度最大的非政府组织，专注于性别和性别少数族裔健康 - 随着研究 孟买和新德里的地点是印度的两个最大城市，有12.5和1680万人 方法：该研究旨在了解次优艺术的模式和高风险群体 与物质使用，污名和其他合成因子有关的依从性和未抑制的病毒负荷 TGW在孟买和印度新德里，并评估潜在的缓冲机制以未来干预 目标。为此，我们建议：（1）对TGW（n = 30）以及临床和社会进行定性访谈 服务提供商（n = 10）评估影响的个体，人际和结构水平的联合因素影响 艺术依从性和未抑制的病毒负荷； （2）表征多级联合因子和 确定孟买和新德里艾滋病毒的150 TGW的高风险概况。我们将进行定量 评估和使用潜在类别分析（LCA）来确定出现的多层次障碍的模式 在AIM 1中，并适合多级模型，以更好地了解已确定的合成类之间的关系 以及未抑制的病毒载荷（通过等离子体病毒负荷测试）和ART依从性（通过自我报告）。来自 R36博士学位论文奖将使用定性和LCA联合风险提供初步数据 个人资料，支持提交更大的NIH赠款，以设计和试点测试一种自适应，多组件 （例如，可能包括药物治疗，弹性应对，技能建设）干预措施以改善艾滋病毒 护理在印度艾滋病毒的TGW生活中的结果继续。