Limited interaction cohort to identify determinants of viral suppression in MSM and transfeminine individuals living with HIV: A multilevel approach

有限的相互作用队列来确定 MSM 和跨性别女性 HIV 感染者病毒抑制的决定因素：多层次方法

• 批准号: 10685845
• 负责人: Aaron Julius Siegler
• 金额: $ 251.09万
• 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: 2023-05-04 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10685845
• 关键词: Attention; Behavior; Black Populations; Black race; Blood specimen; Caring; Characteristics; Cities; Collaborations; Communities; Data; Decision Making; Detection; Development; Discrimination; Enrollment; Environment; Epidemic; Epidemiologic Methods; Frequencies; Geography; HIV; HIV Infections; Health; Health Personnel; Hispanic; Individual; Intervention; Interview; Measures; Medical; Methods; Modeling; Monitor; Neighborhoods; Observational epidemiology; Participant; Pattern; Persons; Policies; Recommendation; Research; Risk; Risk Reduction; Sampling; Sex Behavior; Sexual Partners; Sexual and Gender Minorities; Shapes; Structural Racism; Subgroup; Testing; Time; Viral; Viral Load result; acceptability and feasibility; aged; black men who have sex with men; care seeking; cohort; community-level factor; effective intervention; experience; gender minority group; health care settings; men who have sex with men; multilevel analysis; outcome disparities; prevent; programs; racial disparity; recruit; remote grading; remote monitoring; research study; resilience; sample collection; social; social stigma; socioeconomics; substance use; therapy design; transfeminine; transgender; transmission process; virtual; young men who have sex with men

Abstract For people living with HIV (PLWH), achieving and maintaining viral suppression has critical benefits for their health and for reducing the risk of transmitting HIV to others. Viral suppression is thus a critical cornerstone of the US program to end HIV. However, over a third of people in the US living with HIV do not have a suppressed viral load. Some groups, including younger people and Black people, have lower levels of viral suppression. Although transfeminine people (TFP) have shown rates of viral suppression comparable to other groups, there is ample evidence that they experience a multitude of barriers to sustaining viral suppression, including multiple forms of stigma and structural barriers to accessing culturally appropriate care. In addition, there are wide racial disparities in HIV care among transgender communities, with Black TFP experiencing some of the lowest levels of viral suppression. A deep understanding if required of the circumstances that surround gaining, sustaining or losing viral suppression. Most research to date has focused on individual factors associated with viral suppression status. This approach is limited in that it restricts the consideration of the causes of lack of viral suppression to individual characteristics or behaviors, and misses the broader contexts – stigma, discrimination, lack of health coverage, distance to healthcare providers, and structural racism – that shape the risk of PLWH for losing viral suppression. Further, understanding these multilevel predicators of loss of viral suppression is required to develop interventions that are responsive to the circumstances that shape risks for remaining or becoming unsuppressed. Thus, we propose to enroll and follow a cohort of PLWH – both MSM and TFP – to observe the patterns of gaining, sustaining or losing viral suppression, and to develop information that can be used to inform the development of new interventions to support ongoing engagement in HIV care and viral suppression. Drawing on over a decade of experience in recruiting and retaining sexual and gender minority people in limited- interaction research studies, we will develop nuanced data about the unique factors that shape viral suppression or lack thereof in different critical groups, including Black MSM and TFP, and younger MSM, that are inequitably impacted by lack of viral suppression.

抽象的 对于艾滋病毒感染者 (PLWH) 来说，实现并维持病毒抑制对他们来说至关重要 因此，抑制病毒是实现健康和减少将艾滋病毒传播给他人的风险的重要基石。 美国终止艾滋病毒计划 然而，超过三分之一的美国艾滋病毒感染者没有艾滋病毒。 一些群体，包括年轻人和黑人，病毒载量受到抑制。 尽管跨性别人群 (TFP) 的病毒抑制率与其他人群相当。 群体，有充分的证据表明他们在维持病毒抑制方面遇到了许多障碍， 包括多种形式的耻辱和获得文化上适当的护理的结构性障碍。 变性人社区中的艾滋病毒护理存在巨大的种族差异，黑人 TFP 正在经历 一些最低水平的病毒抑制。 如果需要的话，深入了解获得、维持或失去病毒传播的情况 迄今为止，大多数研究都集中在与病毒抑制状态相关的个体因素上。 这种方法的局限性在于它限制了对病毒抑制不足的原因的考虑 个人特征或行为，而忽略了更广泛的背景——耻辱、歧视、缺乏健康 覆盖范围、与医疗保健提供者的距离以及结构性种族主义——这些因素影响了艾滋病病毒感染者失去病毒的风险 此外，需要了解病毒抑制丧失的这些多级预测因素。 制定针对影响留下或成为风险的情况的干预措施 不受抑制。 因此，我们建议招募并跟踪一群 PLWH（包括 MSM 和 TFP），以观察 获得、维持或失去病毒抑制，并开发可用于告知的信息 制定新的干预措施以支持持续参与艾滋病毒护理和病毒抑制。 拥有十多年在有限的环境中招募和留住性少数群体的经验 相互作用研究，我们将开发有关塑造病毒式传播的独特因素的细致数据 不同关键群体（包括黑人 MSM 和 TFP，以及年轻 MSM）的压制或缺乏， 由于缺乏病毒抑制而受到不公平的影响。