Effects of trauma on retention in HIV care and durable viral suppression among African American men and women

创伤对非裔美国男性和女性继续接受艾滋病毒护理和持久病毒抑制的影响

• 批准号: 10762848
• 负责人: Mary Montilus
• 金额: $ 4.77万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-03 至 2025-04-02
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10762848
• 关键词: Adult; African American; African American population; Ancillary Study; Black race; Caring; Child Sexual Abuse; Childhood; Chronic Disease; Clinical; Clinical Services; Communities; Complex; Continuity of Patient Care; Data; Data Analyses; Data Set; Disease Progression; Ethnic Origin; Fellowship; Foundations; Gender; General Population; Goals; HIV; HIV Seronegativity; HIV Seropositivity; HIV diagnosis; Health; Individual; Knowledge; Life; Long-Term Effects; Longitudinal Studies; Morbidity - disease rate; Outcome; Participant; Partner Abuse; Patients; Persons; Population; Race; Research; Risk; Role; Testing; Time; Trauma; Viral; Viral Load result; Woman; career; design; experience; follow-up; health disparity; health inequalities; health literacy; improved; interpersonal trauma; intimate partner violence; medical appointment; men; mortality; parent project; physical abuse; physical assault; prevent; racial disparity; secondary analysis; sexual assault; sexual trauma; transmission process; treatment adherence; trend; viral rebound

PROJECT SUMMARY People with HIV (PWH) are two to five times more likely to have experienced interpersonal trauma in their lifetime than the general population1-3. Interpersonal trauma (childhood physical abuse, childhood sexual abuse [complex trauma], adult physical and sexual assault, and intimate partner violence [IPV/Adult Partner Abuse]) negatively impacts treatment adherence, retention in care, and viral suppression4-9 and HIV transmission4,39 African Americans (A.A.) bear a disproportionate burden of HIV and trauma2,10-12,39-40. HIV transmission rates and health outcomes differ for men and women with HIV, a difference that may be associated with their experience of trauma13-15. The impact of trauma for A.A. men and women on retention in HIV care, that is, keeping routine medical appointments and durable viral suppression, is not well understood. Long- term retention in HIV care is critical in preventing HIV disease progression, improving treatment adherence and viral load suppression, increasing positive clinical health outcomes and reducing HIV transmission and mortality4. Previous research showed that long-term retention in HIV care among A.A. living with HIV was only 46% at 36 months since the start of HIV care compared to 63% in the nonblack participants4. Results also showed racial disparities in durable viral suppression among A.A. men and women with HIV 4,16 begin at 12 months since the start of HIV care and beyond, increasing the potential risk of HIV transmission 24,33. A.A. account for 40% (479,300) of nearly 1.2 million PWH in the U.S., and 42% of nearly 36,801 new HIV diagnoses in the U.S., while only representing 13% of the U.S. population39-40. A.A. women have the poorest clinical health outcomes11,12 and greater experience of trauma than all races and ethnicities 10-12,17. HIV-positive men experience lower rates of trauma than women with HIV; however, they experience more trauma than HIV- negative men2. Thus far, most studies have used a cross-sectional design to examine relationships between retention in HIV care, viral suppression4, and trauma experiences providing only a snapshot of a single moment in time 12,18. Longitudinal studies are needed for a deeper understanding of the long-term clinical implications of trauma in retention in HIV care and durable viral suppression among the A.A. PWH. The purpose of this F31 fellowship, entitled MIRRORS (TRAUMA & HIV: RETENTION in HIV CARE and VIRAL LOAD SUPPRESSION SAVES LIVES), is to conduct a secondary analysis testing the relative contribution of each type of interpersonal trauma and life stages with experienced trauma (childhood, adulthood) on retention in HIV care and durable viral suppression among A.A. men and women with HIV over 24 months. The proposed study will utilize datasets from R01 MH092286 “Effects of Health Literacy on Health Disparities in HIV Clinical Outcomes” (P.I.: Waldrop), a completed longitudinal study among 700 men and women (n=424 Black/African American) with HIV; and use the parent project’s ancillary study, “Examining Retention in Care and Health Literacy” (ENRICH) (F31- NR017580: PI. A. Anderson).

项目摘要 患有艾滋病毒（PWH）的人在他们的身上遭受人际创伤的可能性要高两到五倍 一生比一般人口1-3。人际创伤（儿童身体虐待，儿童性虐待 [复杂创伤]，成人身体和性侵犯，以及亲密的伴侣暴力[IPV/成人伴侣虐待]） 负面影响治疗依从性，保留保健和病毒抑制4-9和HIV传播4,39 非洲裔美国人（A.A.）的艾滋病毒和创伤的烧伤不成比例。2,10-12,39-40。艾滋病毒传播率 艾滋病毒的男性和女人的健康状况不同，这可能与他们的差异有关 创伤经验13-15。创伤对A.A.的影响男女保留艾滋病毒护理，也就是说 不太了解常规的医疗任命和持久的病毒抑制。长的- 在HIV护理中保留期限对于防止HIV疾病进展，改善治疗依从性和 病毒负荷抑制，增加阳性临床健康结果并减少HIV传播和 死亡率4。先前的研究表明，A.A.的艾滋病毒护理长期保留。与艾滋病毒同住只是 自艾滋病毒开始以来的36个月时，为46％，而非黑人参与者为63％。4。结果也 在A.A.中显示出持久病毒抑制的种族差异艾滋病毒4,16的男性和女人从12岁开始 自艾滋病毒护理及以后的几个月以来，增加了艾滋病毒传播的潜在风险24,33。 A.A. 在美国占40％（479,300）的近120万PWH，近36,801个新的HIV诊断中的42％ 在美国，仅占美国人口的13％39-40。 A.A.女人的临床最差 与所有种族和种族相比，健康成果11,12和创伤经验更高10-12,17。艾滋病毒阳性男人 比艾滋病毒女性的创伤率低；但是，他们经历的创伤比艾滋病毒更多 负男性2。远处，大多数研究都使用了横截面设计来检查 保留艾滋病毒护理，病毒抑制4和创伤经历，仅提供一个单一的快照 时刻12,18。需要更深入地了解长期临床的纵向研究 A.A. PWH。这 该F31奖学金的目的，标题为“镜子”（创伤和艾滋病毒：保留在艾滋病毒和病毒式上 负载抑制挽救生命），是进行二次分析测试，以测试 每种类型的人际创伤和生命阶段，都有经验丰富的创伤（童年，成年） A.A.中的HIV护理和持久的病毒抑制24个月内艾滋病毒的男性和女人。这 拟议的研究将利用R01 MH092286的数据集“健康素养对健康差异的影响 HIV临床结果”（P.I。：Waldrop），一项完成的纵向研究 （n = 424黑人/非裔美国人）与艾滋病毒；并使用父母项目的辅助研究，“检查 护理与健康素养”（富集）（F31- NR017580：PI。A。Anderson）。