Complementary & Alternative Care Behavior in HIV+ Latinos in the US-Mexico

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• 批准号: 7918993
• 负责人: Maria Luisa Zuniga de Nuncio
• 金额: $ 15.69万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7918993
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; Adherence; Ally; Behavior; Behavior Therapy; Caring; Characteristics; Communication; Communities; Complementary and alternative medicine; Development; Disclosure; Disease; Face; Future; Goals; HIV; HIV Seropositivity; Healed; Health; Health Insurance; Health Personnel; Health Services Accessibility; Health system; Healthcare; Improve Access; Intervention; Interview; Interviewer; Knowledge; Latino; Lead; Life; Medicine; Mexico; Modality; Nature; Outcome; Patients; Perception; Pharmacists; Pharmacy facility; Physicians; Phytotherapy; Population; Provider; Reaction; Religion and Spirituality; Reporting; Research; Sampling; Services; Side; Spirituality; Staging; Stigmata; Surveys; System; United States; Work; antiretroviral therapy; care delivery; care seeking; community based participatory research; effective intervention; experience; healing; health care service utilization; health disparity; improved; public health relevance; research study; response; satisfaction; social stigma; therapy adherence

DESCRIPTION (provided by applicant): The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos in the United States (US) - Mexico border region. HIV-positive Latinos in the US face substantial health disparities when compared to non- Latino Whites, including delayed care entry/entering care with advanced HIV disease and they are disproportionately impacted by HIV-stigma and poor patient-provider communication. CAM use (e.g. herbal therapies, alternative healers, and spirituality/religious practices) may be implicated in disparities (e.g. low antiretroviral therapy (ARVs) adherence). Study aims and hypotheses are: Aim 1: To assess CAM-specific health care behavior, including bi-national CAM utilization from allied/alternative health personnel (e.g. pharmacists, non-Western medicine healers) among HIV-positive Latinos residing in Tijuana and San Diego. Hypothesis 1 (H1) Greater use of CAM will be observed among HIV-positive Latinos who report a) crossing the U.S. border more frequently, and b) having migrated to Tijuana or San Diego (e.g. from southern Mexico). Aim 2: To assess use of CAM in the context of HIV treatment utilization and practices, including factors related to delayed entry into HIV care (e.g. HIV stigma); and utilization of and adherence to ARVs among HIV-positive Latinos residing in Tijuana or San Diego. H2.a) Compared to HIV-positive Latinos who report using herbal CAM, those who do not use herbal CAM are more likely to be receiving ARVs and report higher levels of adherence to ARVs; H2.b) Compared to HIV-positive Latinos who do not attend religious services regularly, those who attend religious services regularly are more likely to be receiving ARV; H2.c) Compared to HIV- positive Latinos who report experiencing HIV-related stigma, those who do not report experiencing HIV-related stigma are significantly more likely to be receiving ARV. Aim 3: To determine perceived barriers to communicating use of CAM and ARV adherence to clinicians among HIV-positive Latinos residing in Tijuana or San Diego, including satisfaction with clinician communication, concern about clinician response to reporting CAM use and perception of ARV efficacy; H3) Among CAM users, disclosure of CAM use will be higher among Latino patients who report higher satisfaction with clinician communication than among those who report lower satisfaction. Aim 4: To explore provider and system barriers to culturally-effective communication about CAM and ARV adherence in HIV+ Latinos. In Aims 1-3 we will conduct quantitative, interviewer-administered surveys with 200 HIV+ Latinos (100 from each side of the border). Aim 4 will assess clinician perspectives on CAM through interviews with 20 HIV clinicians on both sides of the border. This study will reduce health disparities in US Latinos by improving culturally-effective clinician communication and will lead to interventions to increase adherence to ARVs and improved health outcomes. PUBLIC HEALTH RELEVANCE: The goal of our community-based participatory research study is to identify the nature and extent of complementary and alternative medicine (CAM) use among HIV-positive Latinos on the San Diego/Tijuana border. CAM use among US Latinos living with HIV is associated with delayed utilization of and poor adherence to antiretroviral therapies (ARVs) that may exacerbate health disparities in HIV care access and health outcomes. This study will lead to development of culturally-effective interventions to improve access and adherence to HIV care in Latinos who face health disparities.

描述（由申请人提供）：我们基于社区的参与性研究的目的是确定美国（美国） - 墨西哥边境地区的HIV阳性拉丁美洲人的互补和替代医学（CAM）使用的性质和程度。与非拉丁裔白人相比，美国的HIV阳性拉丁美洲人面临重大健康差异，包括延迟的护理入境/进入晚期HIV疾病的护理，并且受HIV污名和患者提供差的交流的影响不成比例。 CAM使用（例如草药疗法，替代治疗者和灵性/宗教实践）可能与差异有关（例如低抗逆转录病毒疗法（ARV）遵守）。研究目的和假设是：目标1：评估CAM特异性医疗保健行为，包括居住在蒂华纳和圣​​地亚哥的HIV阳性拉丁美洲人的艾滋病毒阳性拉丁美洲人中的同盟/替代卫生人员（例如药剂师，非西方医学治疗师）。假设1（H1）在报告艾滋病毒阳性的拉丁美洲人中，将观察到cam的使用a）报告a）越来越频繁地越过美国边境，b）迁移到蒂华纳或圣地亚哥（例如，来自墨西哥南部）。目标2：在HIV治疗利用和实践中评估CAM的使用，包括与延迟进入HIV护理有关的因素（例如，HIV污名）；以及居住在蒂华纳或圣地亚哥的HIV阳性拉丁美洲人的ARV的利用和依从性。 H2.A）与使用草药凸轮报告的HIV阳性拉丁美洲人相比，那些不使用草药凸轮的人更有可能接受ARV并报告对ARV的依从性更高； H2.b）与不定期参加宗教仪式的HIV阳性拉丁裔相比，经常参加宗教仪式的人更有可能接受ARV； H2.C）与报告与艾滋病毒相关的污名的艾滋病毒阳性拉丁裔相比，那些没有报告与HIV相关的污名的人更有可能接受ARV。目标3：确定在居住在蒂华纳或圣地亚哥的HIV阳性拉丁美洲裔拉丁美洲裔临床医生中传达CAM和ARV依从性的障碍，包括对临床沟通的满意，对临床医生对CAM使用的关注和对ARV功效的看法的关注； H3）在CAM使用者中，在报告临床医生沟通满意度的拉丁裔患者中，对CAM使用的披露将高于报告较低的满意度的患者。目标4：探索有关CAM和ARV依从性艾滋病毒+拉丁美洲裔cam和ARV依从性的提供者和系统障碍。在AIMS 1-3中，我们将使用200 HIV+ Latinos进行定量的，采访者管理的调查（来自边界的每一侧100）。 AIM 4将通过对边界两侧的20位HIV临床医生的访谈来评估CAM的临床医生观点。这项研究将通过改善文化有效的临床医生的交流来减少美国拉丁美洲人的健康差异，并导致干预措施增加对ARV的依从性并改善健康结果。公共卫生相关性：我们基于社区的参与性研究的目的是确定圣地亚哥/蒂华纳边境上HIV阳性拉丁美洲人使用互补和替代医学（CAM）的性质和程度。美国拉丁裔艾滋病毒的拉丁美洲人使用CAM与对抗逆转录病毒疗法（ARV）的延迟利用和依从性较差有关，这可能会加剧艾滋病毒护理访问和健康结果中的健康差异。这项研究将导致发展具有文化有效的干预措施，以改善面临健康差异的拉丁美洲人的艾滋病毒护理的获取和遵守。