Understanding burden and lived experience of diabetes and hypertension among women living with HIV in the Dominican Republic to improve care integration

了解多米尼加共和国艾滋病毒感染者的糖尿病和高血压负担和生活经历，以改善护理一体化

• 批准号: 10653263
• 负责人: CLARE L BARRINGTON
• 金额: $ 17.78万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10653263
• 关键词: Acute; Adult; Aging; Caribbean region; Caring; Cessation of life; Chronic; Communicable Diseases; Country; Decentralization; Development; Diabetes Mellitus; Diagnosis; Discrimination; Disease; Dominican; Dominican Republic; Educational workshop; Environmental Risk Factor; Epidemiology; Face; Focus Groups; Gender; Goals; Government; HIV; Health; Health Services Accessibility; Healthcare; Healthcare Systems; Hypertension; Inequality; Interruption; Interview; Latin America; Life; Life Style; Mental Depression; Mental Health; Methods; Modeling; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Patients; Personal Satisfaction; Persons; Population; Population Sizes; Poverty; Prediabetes syndrome; Prevalence; Provider; Qualitative Research; Research; Risk; Risk Factors; Self Management; Series; Site; Stress; System; Treatment outcome; Violence; Viral; Vulnerable Populations; Woman; antiretroviral therapy; cardiometabolic risk; care costs; care outcomes; cis-female; cohort; coping; cost; experience; female sex worker; improved; informant; insight; integrated care; low and middle-income countries; mortality; multiple chronic conditions; negative affect; primary care provider; public health relevance; sex; social stigma; stakeholder perspectives; substance use

Project Summary/Abstract: The health context across many low-and-middle-income countries reflects the “epidemiologic transition”, or the shift from higher mortality and morbidity attributable to acute, infectious disease to a higher burden of noncommunicable diseases (NCD). As a result of this transition, countries across Latin America and the Caribbean (LAC) increasingly face a triple burden including: 1) ongoing infectious diseases; 2) increasing NCD; and 3) mental health challenges, including substance use. The triple burden is unevenly distributed with certain populations experiencing disproportionate burden relative to their population size. One particularly vulnerable population is female sex workers (FSW), or cisgender women who consensually exchange sex for money or other goods. Global HIV prevalence among FSW is 10.4% compared to 0.7% among adults worldwide. In the Dominican Republic (DR), the site of the proposed study, adult HIV prevalence is 0.9% compared to 4.2% among FSW. In a cohort of FSW living with HIV in Santo Domingo, our team has documented viral suppression levels ranging from 51% to 73%. Determinants of poor HIV treatment outcomes include depression, substance use, anti-retroviral therapy interruption, and various forms and types of stigma, reflecting the embodiment of the triple burden among FSW living with HIV in this setting. Despite sub-optimal levels of viral suppression, many FSW in the DR access care and treatment through a system of decentralized care centers and live with HIV as a chronic condition. As a result, they are vulnerable to NCD associated with HIV, aging, and environmental factors, in particular type-2 diabetes (T2D) and hypertension (HTN). An estimated 10% of Dominican adults have T2D and 31% HTN. There is no systematic research about NCD among FSW nor understanding of how FSW living with HIV navigate a healthcare system with limited sensitization to their context and needs in the DR or elsewhere. The proposed study aims to improve understanding of the burden of NCD among FSW living with HIV in Santo Domingo. Specific aims are: Aim 1: Describe type 2 diabetes (T2D) and hypertension (HTN) prevalence among sex workers with HIV. For Aim 1, we will re-engage our cohort of FSW living with HIV in Santo Domingo (n=200) to screen for T2D/HTN and assess determinants. Aim 2: Explore the lived experience of multiple chronic conditions among FSW with HIV and T2D/HTN. For Aim 2, we will conduct qualitative in-depth interviews with FSW previously diagnosed with T2D/HTN (n=25) to explore their experiences with healthcare, self-management, mental health, and wellbeing. Aim 3: Identify provider and stakeholder perspectives on integration of care for HIV and T2D/HTN. For Aim 3, we will conduct key informant interviews with providers and stakeholders (n=25) to assess the landscape of HIV and T2D/HTN care and probe on opportunities for integration. We will also facilitate a series of focus groups (n=3) and collaborative workshops to develop a model of integrated care in a collaborative and participatory manner.

项目摘要/摘要： 许多低音收入国家的健康环境反映了“流行性过渡”或你 从更高的死亡率转变为急性，感染性疾病转变为更高的负担 由于这种过渡的结果，非传染性疾病（NCD） 加勒比（LAC）越来越面对三重负担，包括：1）持续的传染性探索； NCD和3）精神健康挑战，包含在内的物质。 某些Poptions相对于他们的人口规模而经历了不稳定的负担 脆弱的人口是女性性工作者（FSW），或者是咨询性交换性行为的cisgender妇女 FSW中的金钱或或或或或或或或或 全球。 FSW中有4.2％的人在圣多明各的艾滋病毒中 记录的病毒抑制水平从51％到73％不等。 包括深度，药物使用，抗逆转录病毒疗法中断以及各种形式和类型的污名， 在这种情况下，反映了FSW与Hive生活的三重负担的体现 病毒抑制水平，许多FSW在DR Access Care和治疗剧院中 护理中心并以艾滋病毒作为慢性病。 HIV，衰老和环境因素，特别是2型糖尿病（T2D）和Hypersion（HTN） 估计多米尼加成年人中有10％的成年人有T2D和31％的HTN。 在fsw中，fsw with with with with with with with with with with with a healthcare strape with Healthcare系统有限 在DR或其他地方，对他们的背景和需求的感觉旨在改善 在圣多明各的艾滋病毒中，对NCD的负担的理解是：AIM 1： 描述艾滋病毒的2型糖尿病（T2D）和高血压（HTN）患病率 AIM 1，我们将重新参与我们在Santo Domingo中与HIV生活的FSW同类（n = 200），以筛选T2D/HTN 并评估决定因素2：探索多种慢性条件的生活经验 FSW和T2D/HTN的AIM 2。 被诊断为T2D/HTN（n = 25），以探索他们在医疗保健，自我管理，心理健康， 和福祉。 T2D/htn。 评估艾滋病毒和T2D/HTN护理的景观，并对我们的融合机会进行调查 促进一系列焦点小组（n = 3）和协作研讨会，以开发一个综合护理模型 协作和参与方式。