Women-centered HIV care practices that facilitate HIV care retention and viral suppression in the presence of adverse sociocultural factors

以妇女为中心的艾滋病毒护理实践，有助于在存在不利社会文化因素的情况下保留艾滋病毒护理和抑制病毒

• 批准号: 9658129
• 负责人: MARY JO TREPKA
• 金额: $ 47.82万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-12 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9658129
• 关键词: AIDS/HIV problem; Address; Adherence; Administrator; Affect; African American; Alcohol or Other Drugs use; Anti-Retroviral Agents; Area; Behavioral Model; Caring; Case Manager; Child Care; Client; Color; Communities; County; Cuban; Data; Device or Instrument Development; Drug usage; Enrollment; Epidemic; Ethnic Origin; Evaluation; Face; Gender; Goals; HIV; HIV Infections; HIV diagnosis; Haitian; Health; Health Personnel; Health Services Accessibility; Healthcare; Healthcare Systems; Immigrant; Immigration; Individual; Intake; International; Interview; Laboratories; Language; Latina; Mental Depression; Methods; Minority; Minority Recruitment; Neighborhoods; Outcome; Patient-Centered Care; Patients; Policies; Poverty; Provider; Race; Research; Surveys; System; Treatment outcome; United States; United States National Institutes of Health; Viral; Woman; Women' s Health; antiretroviral therapy; billing data; care burden; care delivery; care outcomes; care systems; design; disparity reduction; ethnic minority population; experience; health disparity; improved; improved outcome; instrument; low socioeconomic status; men; metropolitan; mortality; multilevel analysis; programs; racial and ethnic; racial minority; retention rate; social stigma; success; therapy adherence; transmission process; treatment disparity

PROJECT SUMMARY Achieving high rates of retention in human immunodeficiency virus (HIV) care and adherence to antiretroviral therapy leads to high rates of viral suppression, which not only reduces mortality and improves quality of living, among people living with HIV infection, but also reduces HIV transmission within affected communities. HIV care outcomes among women have been suboptimal; in 2014, viral suppression was 52.6% among African Americans, 57.9% among Whites, and 59.8% among Latinas compared with 66.0% among White men. Women living with HIV infection are more likely to face barriers to successful HIV care such as child care burden, abuse, and extreme poverty than men. In addition, women, in particular women of color, can face multiple layers of stigma including those related to their race, ethnicity, HIV infection, drug use, and poverty status. Partly because the HIV epidemic initially affected mostly men, the HIV care system is not designed to meet women's special needs. Implementing women-centered HIV care has been proposed nationally and internationally as a way to address women's needs. However, this idea has not been well operationalized for HIV care and has not been examined in the context of the United States health care system including the Ryan White Program, which serves 65% of women living with HIV in the United States. Our central hypothesis is that the more women-centric a system is, the higher the likelihood of HIV care retention and viral suppression among women. The objective of this application is to identify effective provider and system women-centered HIV care practices within the Ryan White Program that positively influence HIV care retention and viral suppression among women experiencing sociocultural challenges. We will accomplish this objective with a mixed methods study examining patient intake and billing data from women enrolled in the Miami-Dade County Ryan White Program, conducting in-depth interviews with case managers, health care providers, administrators, and women living with HIV, and conducting a survey of 600 women living with HIV in the Miami- Dade County Ryan White Program. We propose the following three specific aims: 1) Identify sociocultural factors that influence HIV care retention and viral suppression, including those unique to women and those having a differential impact on African American, Haitian and Latina women; 2) Ascertain current and potential health care provider and system women-centered HIV care practices that may mitigate the effect of adverse sociocultural factors on HIV care retention and antiretroviral therapy adherence; 3) Identify specific health care provider and system women-centered HIV care practices that most strongly influence HIV care retention, adherence, and viral suppression among all women and in African American, Haitian and Latina women. This project addresses the National HIV/AIDS Strategy goals to increase access to care, improve health outcomes, and reduce HIV-related health disparities and the Trans-NIH Plan for HIV-Related Research call for research to promote HIV care engagement and to reduce disparities in treatment outcomes.

项目概要 实现人类免疫缺陷病毒 (HIV) 护理的高保留率和抗逆转录病毒药物的依从性 治疗导致高病毒抑制率，这不仅降低死亡率并提高生活质量， 不仅在艾滋病毒感染者中传播，而且还减少了受影响社区内的艾滋病毒传播。艾滋病病毒 妇女的护理结果并不理想； 2014年，非洲人的病毒抑制率为52.6% 美国人中，白人中这一比例为 57.9%，拉丁裔中为 59.8%，而白人中这一比例为 66.0%。 感染艾滋病毒的女性更有可能面临成功的艾滋病毒护理障碍，例如儿童保育 与男性相比，负担、虐待和极端贫困。此外，女性，尤其是有色人种女性，可能会面临 多层次的耻辱，包括与种族、民族、艾滋病毒感染、吸毒和贫困有关的耻辱 地位。部分原因是艾滋病毒流行最初影响的主要是男性，艾滋病毒护理系统的设计目的并不是为了 满足女性的特殊需求。国家和地区已提议实施以妇女为中心的艾滋病毒护理 在国际上作为满足妇女需求的一种方式。然而这个想法并没有得到很好的实施 艾滋病毒护理尚未在美国医疗保健系统（包括瑞安医院）的背景下进行审查 White Program 为美国 65% 的艾滋病毒感染者提供服务。我们的中心假设是 系统越以女性为中心，保留艾滋病毒护理和抑制病毒的可能性就越高 在女性中。该应用程序的目的是确定有效的提供者和以女性为中心的系统 Ryan White 计划中的艾滋病毒护理实践对艾滋病毒护理保留和病毒传播产生积极影响 遭受社会文化挑战的妇女受到压制。我们将通过以下方式实现这一目标 混合方法研究检查了迈阿密戴德县注册女性的患者入院率和账单数据 Ryan White 计划，对病例经理、医疗保健提供者进行深入访谈， 管理人员和感染艾滋病毒的妇女，并对迈阿密的 600 名感染艾滋病毒的妇女进行了调查 戴德县瑞恩·怀特计划。我们提出以下三个具体目标：1）确定社会文化 影响艾滋病毒护理保留和病毒抑制的因素，包括女性特有的因素和那些 对非裔美国、海地和拉丁裔妇女产生不同的影响； 2) 确定电流和电位 卫生保健提供者和系统以妇女为中心的艾滋病毒护理实践可以减轻不良影响 影响艾滋病毒护理保留和抗逆转录病毒治疗依从性的社会文化因素； 3) 确定具体的医疗保健 提供者和系统以女性为中心的艾滋病毒护理实践对艾滋病毒护理保留的影响最大， 所有女性以及非裔美国、海地和拉丁裔女性的坚持和病毒抑制。这 项目涉及国家艾滋病毒/艾滋病战略目标，以增加获得护理的机会、改善健康结果、 并减少与艾滋病毒相关的健康差距，跨国家卫生研究院艾滋病毒相关研究计划呼吁开展研究 促进艾滋病毒护理参与并减少治疗结果的差异。