Understanding multilevel barriers and facilitators to HIV treatment among marginalized women living with HIV in the context of intersecting HIV, TB, and COVID-19 pandemics

了解在艾滋病毒、结核病和 COVID-19 交叉流行的背景下，边缘化艾滋病毒感染者接受艾滋病毒治疗的多层次障碍和促进因素

• 批准号: 10480527
• 负责人: Carrie Elizabeth Lyons
• 金额: $ 4.68万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10480527
• 关键词: Adherence; Adoption; Advocacy; Affect; Africa South of the Sahara; Behavioral; Burkina Faso; COVID-19; COVID-19 pandemic; Cause of Death; Cessation of life; Communities; Complex; Country; Data; Diagnosis; Economics; Epidemic; Epidemiology; Gender; Ghana; Goals; HIV; HIV/TB; Health; Health Policy; Healthcare; Individual; Intercept; International Agencies; Intervention; Ivory Coast; Kenya; Lesotho; Letters; Logistic Regressions; Methods; Modeling; Nigeria; Outcome; Patient Self-Report; Personal Satisfaction; Persons; Pharmaceutical Preparations; Policies; Poverty; Prevention program; Research; Risk Factors; Role; Source; Time; Togo; Training; Tuberculosis; Tuberculosis diagnosis; Violence; Viral; Woman; Women' s Health; antiretroviral therapy; barrier to care; base; experience; gender-based violence; improved; indexing; markov model; member; mortality; pandemic disease; pre-doctoral; pressure; programs; response; skills; social; social stigma; social structure; treatment adherence; treatment program; tuberculosis treatment

PROJECT SUMMARY/ABSTRACT Specific Aims: The overarching goal of this proposed study is to assess social and structural factors associated with antiretroviral therapy (ART) use and recent TB diagnosis among women living with HIV; and evaluate the potential impact of policies in controlling HIV. Specially, we aim to 1: Assess the associations between violence, economic, healthcare, and policy barriers and ART use among women living with HIV; 2. Characterize the associations between social, economic, healthcare, and policy barriers and recent TB diagnosis among women living with HIV; and 3. Estimate the potential impact of policy adoption of universal healthcare coverage for ART, non-discrimination protections, and gender-based violence protections on viral suppression, TB diagnosis, and deaths among women living with HIV. Significance: People living with HIV (PLHIV) are 19 times more likely to develop active TB, which is the leading cause of death in persons with HIV. Progress in combating HIV and TB has been made through integration of HIV/TB programs and efforts towards the UNAIDS goals for epidemic control. However, the emergence of COVID-19 and disruptions in prevention and treatment programs threaten efforts to control these pandemics. COVID-19 has also exacerbated gender inequities, because of economic pressures, violence, and stigmas affecting women. Structural barriers including discriminatory policies and poverty worsen the challenges faced by women and impede progress in controlling HIV and TB. In response, WHO and UNAIDS have prioritized the adoption of policies for universal healthcare coverage of ART, non-discrimination protections, and gender-based violence protections. Poor treatment adherence among women living with HIV contributes to TB progression and mortality; and complicates progress in epidemic control. This study aims to assess the role of social and structural factors affecting women living with HIV and provide direct and actionable evidence to inform policy changes and improve the health of women living with HIV. Approach: We will leverage data from 8646 women living with HIV in 8 countries in sub–Saharan Africa between 2020-2021 who participated in the PLHIV Stigma Index 2.0. We will use multilevel logistic regression models with random intercepts to assess factors associated with ART use (Aim 1) and factors associated with recent TB diagnosis (Aim 2). Lastly, for aim 3 we will utilize a Markov model to assess the potential impact of policy adoption on viral suppression, TB progression, and death among women living with HIV in Lesotho. Training information: Carrie Lyons’ training will consist of advanced methods specific to HIV and TB; advanced methods in social and behavioral epidemiology to appropriately incorporate contextual and structural level factors, and the use of multiple sources and types of data; and advanced methods in causal inference and methods for the analysis of observational data.

项目概要/摘要 具体目标：这项拟议研究的总体目标是评估相关的社会和结构因素 艾滋病毒感染妇女中抗逆转录病毒治疗（ART）的使用和最近的结核病诊断，并评估 具体来说，我们的目标是 1：评估暴力、艾滋病毒和艾滋病毒之间的关联。 艾滋病毒感染者的经济、医疗保健和政策障碍以及抗逆转录病毒治疗的使用 2. 描述感染者的特征； 社会、经济、医疗保健和政策障碍与女性近期结核病诊断之间的关联 艾滋病毒感染者；以及 3. 评估针对 ART 实行全民医疗保健政策的潜在影响， 病毒抑制、结核病诊断和预防方面的非歧视保护和基于性别的暴力保护 感染艾滋病毒的妇女的死亡人数。 意义：艾滋病毒感染者 (PLHIV) 罹患活动性结核病的可能性高出 19 倍，这是导致结核病的主要原因 艾滋病毒感染者的死亡原因。通过整合艾滋病毒和结核病防治工作取得了进展。 艾滋病毒/结核病规划和艾滋病规划署为实现流行病控制目标所做的努力。 COVID-19 以及预防和治疗计划的中断威胁到了控制这些流行病的努力。 由于经济压力、暴力和耻辱，COVID-19 还加剧了性别不平等 歧视性政策和贫困等结构性障碍使妇女面临的挑战更加恶化。 为应对这一问题，世界卫生组织和联合国艾滋病规划署优先考虑了以下问题： 采用抗逆转录病毒疗法全民医疗保健覆盖、非歧视保护和基于性别的政策 艾滋病毒感染者的治疗依从性差会导致结核病的进展和 本研究旨在评估社会和结构的作用。 影响艾滋病毒感染者妇女的因素，并提供直接和可操作的证据来指导政策变化和 改善感染艾滋病毒的妇女的健康。 方法：我们将利用撒哈拉以南非洲 8 个国家 8646 名感染艾滋病毒的女性的数据 2020-2021 年参与 PLHIV 耻辱指数 2.0 的人我们将使用多级逻辑回归模型。 使用随机截距来评估与 ART 使用相关的因素（目标 1）以及与近期结核病相关的因素 最后，对于目标 3，我们将利用马尔可夫模型来评估政策采用的潜在影响。 关于莱索托艾滋病毒感染妇女的病毒抑制、结核病进展和死亡的研究。 培训信息：Carrie Lyons 的培训将包括针对艾滋病毒和结核病的高级方法； 社会和行为流行病学中适当纳入背景和结构水平的方法 因素，以及多种来源和类型的数据的使用；以及因果推理和分析的先进方法。 观测数据分析方法。