Barriers to Care & Treatment Practices in HIV+ Latinos in US-Mexico Border Region

护理障碍

• 批准号: 7645604
• 负责人: Maria Luisa Zuniga de Nuncio
• 金额: $ 15.31万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-06-26 至 2011-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7645604
• 关键词: AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Administrator; Alternative Medicine; Behavior; Behavioral; Behavioral Model; Budgets; California; Caring; Characteristics; Code; Communities; Community Developments; Complementary and alternative medicine; Consensus; County; Data Collection; Development; Disease; Face; Folk Medicine; Geographic state; Goals; HIV; HIV Seropositivity; Health Care Seeking Behavior; Health Services; Herb; Herbal Medicine; Hispanics; Interview; Interviewer; Latino; Lead; Life; Logistic Regressions; Measures; Methods; Mexico; Minority Groups; Participant; Patients; Persons; Plant Roots; Plants; Provider; Qualitative Methods; Qualitative Research; Recruitment Activity; Religion and Spirituality; Reporting; Research; Research Methodology; Research Personnel; Sampling; Services; Side; Societal Factors; Solutions; Spirituality; Staging; Stigmata; Surveys; System; Testing; United States; Vitamins; base; care delivery; care seeking; community based participatory research; design; experience; health care delivery; health disparity; improved; meetings; optimism; public health relevance; research study; social stigma; theories

DESCRIPTION (provided by applicant): The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. California ranks among the top five states with highest numbers of Latino AIDS cases and Latinos comprise 66% of reported HIV cases in San Diego County's southern region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). We will assess barriers to HIV care and care practices among Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors. We propose a community-based binational collaborative study that builds on existing academic-community partnerships and employs quantitative and qualitative methods to address aims. Aim 1: To assess binational health care seeking behavior and HIV treatment utilization, including access to ARVs and use of CAM (e.g. folk medicine, herbal medicine) among HIV-positive Latinos who currently reside in Tijuana, Baja California, Mexico or San Diego, CA. Aim 2: To determine specific barriers to HIV care, including manifestations of HIV-related stigma, mobility and spirituality/religiosity among HIV-positive Latinos who reside in Tijuana and San Diego. Aim 3: To explore provider and system-level barriers to continuity of HIV care and receipt of ARVs in HIV-positive Latinos within the health care delivery context of both sides of the US- Mexico border. To address Aims 1 and 2 we will conduct a quantitative study, based on interviewer- administered surveys with 200 HIV-positive persons (100 participants recruited from both sides of border). We will use descriptive and multivariate logistic regression statistical analyses to test specific hypotheses. To meet Aim 3, we will purposively sample 20 providers/administrators, conducting in-depth interviews on experiences with patient barriers to HIV care. Following Grounded Theory methods, data collection and analysis will include development and revision of interview guides using constant comparison method. The investigator team will independently code and reach consensus on interview coding to reflect themes/issues, accounts of behaviors, and opinions on organizational/system characteristics that influence health services. This study will decrease health disparities in HIV-positive Latinos through improved understanding of HIV care-seeking behavior; HIV care practices}including CAM use; development of community-based and culturally-relevant research methods and measures; and advancing efforts to positively impact care delivery in Latinos living in the US- Mexico border region and in other US Latino populations living with HIV/AIDS. PUBLIC HEALTH RELEVANCE The goal of our community-based participatory research study is to identify barriers to HIV care among HIV- positive Latinos in the U.S.-Mexico border region. Latinos face substantial barriers to HIV care and enter care at advanced stages of HIV disease, but reasons for this are poorly understood, and could involve issues related to stigma, HIV treatment optimism and use of traditional, complementary and/or alternative medicines (CAM). The proposed study will assess barriers to HIV care and care practices among HIV-positive Latinos in the U.S.-Mexico border region applying Andersen & Aday's Behavioral Model of Health Services Use as our conceptual framework to study environmental, structural, behavioral and societal factors.

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 - 墨西哥边境地区艾滋病毒阳性拉丁裔艾滋病毒护理的障碍。加利福尼亚州排名最多的拉丁裔艾滋病案件数量最多的州，拉丁美洲人占圣地亚哥县南部地区报告的HIV病例的66％。拉丁美洲人面临着艾滋病毒护理的实质性障碍，并在艾滋病毒疾病的高级阶段进入护理，但理解的原因很少，并且可能涉及与污名，艾滋病毒治疗乐观和使用传统，补充和/或替代药物（CAM）有关的问题。我们将评估美国 - 墨西哥边境地区拉丁裔艾滋病毒护理和护理实践的障碍，应用安德森和阿达的卫生服务行为模型将其用作我们研究环境，结构，行为，行为和社会因素的概念框架。我们提出了一项基于社区的双原则协作研究，该研究以现有的学术社区合作伙伴关系为基础，并采用定量和定性方法来解决目标。目的1：评估本地医疗保健寻求行为和艾滋病毒治疗利用，包括获得ARVS和CAM的使用（例如，民间医学，草药，草药）的HIV阳性拉丁裔，他们目前居住在蒂华纳，墨西哥巴哈，墨西哥或圣地亚哥。目标2：确定艾滋病毒护理的特定障碍，包括居住在蒂华纳和圣​​地亚哥的艾滋病毒阳性拉丁裔的艾滋病毒相关污名，流动性和灵性/宗教信仰。目标3：探索艾滋病毒护理连续性的提供者和系统级别的障碍，并在美国 - 墨西哥边境两侧的医疗保健提供环境中艾滋病毒阳性拉丁裔的ARV接收。为了解决目标1和2，我们将基于对200名HIV阳性人（从边境两边招募的100名参与者）进行访调员的调查进行定量研究。我们将使用描述性和多元逻辑回归统计分析来检验特定假设。为了满足AIM 3，我们将有目的地对20位提供商/管理员进行样品，对患者艾滋病毒护理的患者障碍进行深入访谈。遵循扎根的理论方法，数据收集和分析将包括使用恒定比较方法对访谈指南的开发和修订。研究者团队将独立编码并就面试编码达成共识，以反映主题/问题，行为的说明以及对影响卫生服务的组织/系统特征的意见。这项研究将通过改善对艾滋病毒护理行为的了解，从而降低HIV阳性拉丁裔的健康差异； HIV护理实践}包括使用CAM；发展基于社区和文化的研究方法和措施；并努力努力影响居住在美国 - 墨西哥边境地区和其他患有艾滋病毒/艾滋病的美国拉丁裔人口的拉丁美洲人的护理服务。公共卫生相关性我们基于社区的参与性研究的目标是确定美国 - 墨西哥边境地区的HIV-Latinos中艾滋病毒护理的障碍。拉丁美洲人面临着艾滋病毒护理的实质性障碍，并在艾滋病毒疾病的高级阶段进入护理，但理解的原因很少，并且可能涉及与污名，艾滋病毒治疗乐观和使用传统，补充和/或替代药物（CAM）有关的问题。拟议的研究将评估美国 - 墨西哥边境地区HIV阳性拉丁美洲人的艾滋病毒护理和护理实践的障碍，应用了安德森和阿德的卫生服务行为模型，将我们的卫生服务行为模型用作我们研究环境，结构，行为，行为和社会因素的概念框架。