Rapid ART and HIV Care Engagement Among Young Black and Latinx Sexual and Gender Minorities with HIV: A Mixed Methods Study

感染艾滋病毒的年轻黑人和拉丁裔性少数群体的快速抗逆转录病毒疗法和艾滋病毒护理参与：一项混合方法研究

• 批准号: 10797771
• 负责人: Marya Gwadz
• 金额: $ 20.8万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10797771
• 关键词: Address; Adult; African American; Age; Appointment; Behavior; Biological Markers; Black race; Caring; Characteristics; Cities; Cohort Studies; Consensus; Continuity of Patient Care; Data; Decision Making; Demographic Factors; Development; Diagnosis; Discrimination; Disparity; Drug usage; Ecological momentary assessment; Eligibility Determination; Enrollment; Epidemic; Equity; Evaluation; Focus Groups; Fostering; Funding; Future; HIV; HIV diagnosis; Housing; Individual; Information Dissemination; Insurance; International; Intervention; Interview; Knowledge; Latinx; Literature; Measures; Mediating; Medical; Mental Health; Methodology; Methods; National Institute of Drug Abuse; New York City; Newly Diagnosed; Outcome; Parents; Participant; Patient Recruitments; Patients; Pattern; Perception; Persons; Policies; Policy Maker; Population; Prevalence; Process; Protocols documentation; Provider; Psychosocial Factor; Reporting; Role; Sampling; Sexual and Gender Minorities; Site; Surveys; Time; Viral; Viral Load result; Visit; Work; Youth; age group; age related; antiretroviral therapy; barrier to care; behavioral and social science; clinical care; contextual factors; design; distrust; drug use screening; emerging adult; empowerment; ethnic minority; experience; gender minority; gender minority youth; improved; longitudinal, prospective study; minority disparity; parent grant; policy recommendation; programs; racial minority; recruit; sexual minority; social; social stigma; substance use; systemic barrier; theories; tool

PROJECT SUMMARY Parent Grant: Young people living with HIV (LWH) in the developmental periods ages 16-28 years, which we refer to as “youth and emerging adults” (YEA), have the lowest rates of engagement along the HIV care continuum (HCC), most pronounced for African American/Black and Latinx YEA-LWH. Yet, our knowledge of factors that promote or impede engagement along the HCC is insufficient. The mixed methods prospective longitudinal study focuses on African American/Black and Latinx (AABL) YEA-LWH (ages 16-28 years with HIV in NYC and Newark, NJ, N=270) both with and without viral suppression and uses quantitative, qualitative, biomarker (HIV viral load, drug use), and ecological momentary assessment approaches to uncover, describe, and better understand factors contributing to trajectories of engagement along the HCC over time, with precision, including from YEA-LWH’s perspectives. Proposed Supplement: Rapid ART has become standard policy in HIV treatment on the international, national, and local levels over the last few years. As HIV clinical care sites move to rapid ART implementation, it is important to understand the contextual factors that influence decision making and behavior at this critical juncture along the HCC. While the literature mainly explores the perspectives and experiences of people newly diagnosed adults with HIV, there is a dearth of understanding around YEA-LWH who have been out of care and/or decide to re-engage in care and reinitiate rapid ART. In addition, the U.S. HIV epidemic is characterized by persistent disparities for younger people as well as racial/ethnic, gender, and sexual minorities. It is vital to illuminate the barriers, facilitators, and important contextual factors that influence decisions and behaviors regarding ART re-initiation for AABL sexual and/or gender minority (SGM) YEA-LWH. These critical questions have not yet been explored in the literature. This mixed methods supplement proposal will involve a quantitative analysis of the R01 parent study data examining associations between rapid ART initiation at diagnosis (which is not an aspect of the parent study), demographic and psychosocial factors (substance use, mental health, HIV-related stigma, intersectional stigma, medical distrust, and discrimination), and HIV care engagement. We hypothesize that rapid ART will be associated with HIV care disengagement. For the qualitative portion, we will sample a group of 30 participants recruited from the parent study, half recently re-engaged in care/re-initiating ART and half disengaged/not on ART, to participate in in-depth interviews, Photovoice methodology and focus group discussions to explore the aforementioned psychosocial factors and elicit and describe other emergent contextual factors, driven by a multi-level approach grounded in social action theory. The results from this supplement will contribute to equity-focused recommendations for policy-makers and providers to support AABL SGM YEA-LWH in HIV care re-engagement and rapid ART initiation.

项目概要 家长补助金：16-28 岁发育期的艾滋病毒感染者 (LWH) 青少年，我们 被称为“青年和新兴成年人”(YEA)，在艾滋病毒护理方面的参与率最低 连续体 (HCC)，对于非裔美国人/黑人和拉丁裔 YEA-LWH 最为明显。 促进或阻碍 HCC 参与的因素还不够充分。 纵向研究重点关注非裔美国人/黑人和拉丁裔 (AABL) YEA-LWH（16-28 岁艾滋病毒感染者） 在纽约市和新泽西州纽瓦克，N=270），有或没有病毒抑制，并使用定量、定性、 生物标志物（HIV 病毒载量、药物使用）和生态瞬时评估方法来发现、描述、 并更好地了解随着时间的推移影响 HCC 参与轨迹的因素， 精度，包括从 YEA-LWH 的角度来看：快速 ART 已成为标准。 过去几年国际、国家和地方层面的艾滋病毒治疗政策。 护理站点转向快速实施 ART，了解影响的背景因素非常重要 HCC 的这一关键时刻的决策和行为。 新诊断的成人艾滋病毒感染者的观点和经历，有深入的了解 已经脱离护理和/或决定重新接受护理并重新开始快速 ART 的 YEA-LWH 患者。 此外，美国艾滋病毒流行的特点是年轻人之间的持续差异以及 阐明种族/族裔、性别和性少数群体的障碍、促进因素和重要因素至关重要。 影响有关 AABL 性和/或性行为重新启动 ART 的决策和行为的背景因素 性别少数群体（SGM）YEA-LWH。这些关键问题尚未在文献中探讨过。 混合方法补充提案将涉及 R01 母研究数据的定量分析 检查诊断时快速开始 ART 之间的关联（这不是母研究的一个方面）， 人口和心理社会因素（药物使用、心理健康、艾滋病毒相关耻辱、交叉 污名、医疗不信任和歧视）以及艾滋病毒护理参与度。 对于定性部分，我们将对 30 名参与者进行抽样。 从家长研究中招募的患者中，一半最近重新参与护理/重新开始 ART，一半脱离/未参与 ART，参与深度访谈、Photovoice 方法论和焦点小组讨论，以探索 提到的社会心理因素，并引出和描述其他新兴的情境因素，这些因素是由 以社会行动理论为基础的多层次方法，本补充材料的结果将有助于 为政策制定者和提供者提供以公平为中心的建议，以支持艾滋病毒领域的 AABL SGM YEA-LWH 护理重新参与和快速 ART 启动。