Disparities in the HIV Care Continuum among Hispanics in the United States

美国西班牙裔人群艾滋病毒护理连续性的差异

• 批准号: 9293885
• 负责人: Fidel Desir Boya
• 金额: $ 4.9万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9293885
• 关键词: AIDS prevention; AIDS/HIV problem; Acculturation; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Alcohol consumption; American; Area; Baltimore; Behavioral; Benchmarking; Caring; Cities; Clinic; Clinical; Collaborations; Complex; Continuity of Patient Care; Data; Data Sources; Demographic Factors; Development; Diagnosis; Disease Progression; Epidemic; Ethnic group; Event; Face; Failure; Goals; HIV; HIV Infections; HIV diagnosis; Health; Health Insurance; High Prevalence; Hispanics; Incidence; Individual; Infection; Institute of Medicine (U.S.); Intervention; Interview; Language; Link; Longevity; Measures; Medical; Monitor; Nature; Not Hispanic or Latino; Outcome; Persons; Population; Population Attributable Risks; Population Intervention; Positioning Attribute; Preventive Intervention; Qualitative Research; Race; Reporting; Research; Research Design; Research Methodology; Risk; Risk Factors; Source; Substance abuse problem; Time; United States; Update; Viral; antiretroviral therapy; clinical care; cohort; design; experience; health disparity; high risk population; improved; prevent; public health intervention; public health relevance; racial and ethnic; therapy design; time use; transmission process; trend; virology

 DESCRIPTION (provided by applicant): The HIV epidemic has disproportionately affected the Hispanic population in the United States (US). Hispanics face the second-highest prevalence and incidence rates of HIV. Hispanics are also more likely to receive HIV care at later stages of HIV disease progression relative to any other racial or ethnic group. A complex set of unique individual- and structural-level factors confront this population and contribute to the burden of health disparities in HIV care and treatment experienced by Hispanics. In 2015, the National HIV/AIDS Strategy for the United States: Updated to 2020 (NHAS) set forth goals to reduce HIV-related disparities in high-risk populations, such as Hispanics, and to increase the proportion of individuals successfully engaged at all levels of the spectrum of HIV care and treatment. This spectrum, termed the HIV care continuum (HIVCC), has become a high-priority area for intervention. Increasing the proportions of HIV-infected individuals who progress through and ultimately reach the last stage of the HIVCC (viral suppression) has been shown to prevent over 90% of new HIV infections. To address the Hispanic population's unique HIV-related needs, it is critical to monitor trends in HIV care indicators for improvement over time and to identify the factors underlying HIV care in this population for the development of tailored public health interventions. We aim to: 1) estimate trends in the proportion of adult Hispanics that were in the last three steps of the HIVCC (retention in HIV care, prescription of antiretrovirl therapy [ART], and viral suppression) from 2004 to 2014; 2) identify demographic factors and behavioral targets for interventions to improve retention in HIV care, ART use, and viral suppression among Hispanic adults in HIV care in the US; and 3) explore the nature of progression through the last three steps of the HIVCC among adult Hispanics and identify the structural-level barriers and facilitators influencing this progression using qualitative research methods. For Aims 1 and 2, we will use data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). The NA-ACCORD offers the largest-available source of longitudinal data on HIV- infected Hispanics (>15,000) in the US and has been endorsed by the Institute of Medicine as an appropriate data source for monitoring progress in NHAS goals. We will conduct qualitative in-depth interviews (N=25) with HIV-infected Hispanics in Baltimore City in Aim 3 to obtain a rich, complementary understanding of structural- level factors influencing HIVCC proportions among Hispanics. The results of this research will inform strategies designed to achieve NHAS goals to reduce health disparities and improve HIV care among Hispanics.

 描述（由适用提供）：艾滋病毒流行对美国的西班牙裔人口（美国）影响不成比例。西班牙裔面临第二高的艾滋病毒患病率和发病率。相对于任何其他种族或族裔，西班牙裔也更有可能在艾滋病毒疾病进展的后期接受艾滋病毒护理。一组复杂的独特个人和结构水平的因素面临着这一人群，并有助于西班牙裔艾滋病毒护理和治疗经验中的健康差异。 2015年，美国的全国艾滋病毒/艾滋病战略：更新到2020年（NHAS）制定了目标，以减少高风险人群（例如西班牙裔）的艾滋病毒相关差异，并增加在HIV护理和治疗方面成功参与的个人的比例。该频谱称为HIV护理连续体（HIVCC），已成为干预的高优先级领域。已证明，增加并最终达到HIVCC（病毒抑制）的HIV感染个体的比例已被证明可预防超过90％的新HIV感染。为了满足西班牙裔人群与HIV独特的需求，监测随着时间的推移改善HIV护理指标的趋势，并确定该人群中艾滋病毒护理的因素以开发量身定制的公共卫生干预措施。我们的目的是：1）从2004年至2014年，在HIVCC的最后三个步骤（保留HIV Care，ART疗法和病毒抑制的处方处方）的成年西班牙裔比例的趋势； 2）确定干预措施的人口因素和行为目标，以改善美国西班牙裔成年人艾滋病毒护理中的艾滋病毒护理，艺术使用和病毒抑制； 3）在成人西班牙裔中，通过HIVCC的最后三个步骤探索进展的性质，并使用定性研究方法确定结构层面的障碍和促进因素。对于目标1和2，我们将使用北美艾滋病队列研究与设计合作（NA-Accord）的数据。 NA-Accord在美国提供了有关HIV感染的西班牙裔（> 15,000）的纵向数据最大的来源，并已得到医学研究所的认可，作为监测NHAS目标进展的适当数据源。我们将对AIM 3的Baltimore City的HIV感染西班牙裔的西班牙裔人进行定性的深入访谈（n = 25），以获得对影响西班牙裔HIVCC比例的结构性因素的丰富，完全理解。这项研究的结果将为旨在实现NHAS目标的战略提供信息，以减少健康差异并改善西班牙裔艾滋病毒的护理。