Advancing knowledge on factors that promote or impede engagement along the HIV care continuum over time: A longitudinal mixed methods study of Black and Latinx youth/emerging adults living with HIV

随着时间的推移，增进对促进或阻碍艾滋病毒护理连续体参与的因素的了解：针对感染艾滋病毒的黑人和拉丁裔青年/新兴成年人的纵向混合方法研究

• 批准号: 10273344
• 负责人: Marya Gwadz
• 金额: $ 76.12万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10273344
• 关键词: Adherence; Adolescence; Adult; African American; Age; Alcohol consumption; Appointment; Behavior; Behavioral; Biological Markers; Biological Testing; Biometry; Caring; Centers for Disease Control and Prevention (U.S.); Cognitive; Continuity of Patient Care; Data; Development; Diagnosis; Drug usage; Ecological momentary assessment; Enrollment; Epidemic; Family Relationship; HIV; HIV risk; Health; Health Services; Healthcare; Homophobia; Hybrids; Individual; Intervention; Interview; Knowledge; Latinx; Literature; Longitudinal Studies; Longitudinal prospective study; Medical; Mental Health; Methods; Minority; Modeling; Motivation; New York City; Outcome; Participant; Pharmaceutical Preparations; Policies; Process; Public Health; Recommendation; Reporting; Research; Resources; Risk; Sampling; Services; Sexual and Gender Minorities; Social Interaction; Social Network; Structure; Testing; Time; United States; United States National Institutes of Health; Viral; Viral Load result; Vulnerable Populations; Youth; age group; antiretroviral therapy; base; drug testing; emerging adult; emerging adulthood; experience; follow-up; health care service; health care settings; high risk; innovation; longitudinal design; low socioeconomic status; microsystems; peer; primary outcome; prospective; protective factors; psychologic; racism; recruit; secondary outcome; social; substance use; substance use treatment; theories; therapy adherence

PROJECT SUMMARY: Young people living with HIV (LWH) in the developmental periods from adolescence to emerging adulthood (ages 16-28 years), which we refer to as “youth and emerging adults” (YEA), have the lowest rates of engagement along the HIV care continuum (HCC) of any age group. This poor engagement is most pronounced for African American/Black and Latinx YEA-LWH, including sexual/gender minorities, those who use alcohol/drugs, and individuals from low socioeconomic status backgrounds. Yet, our knowledge of factors that promote or impede engagement along the HCC, and how they operate and interplay over time, is insufficient, for both limited occurrence behaviors (e.g., HIV care appointments) and repeated occurrence behaviors (e.g., ART adherence). These gaps limit innovations to policy and health services. The proposed prospective longitudinal study uses mixed methods and focuses on African American/Black and Latinx YEA- LWH both with and without viral suppression. The study uses quantitative, qualitative, biomarker (HIV viral load, drug use), and ecological momentary assessment approaches to uncover, describe, and better understand factors contributing to trajectories of engagement along the HCC over time, with precision, including from YEA-LWH’s perspectives. The study is grounded in Social Action Theory, a comprehensive social-cognitive/ecological model that allows for examination of changes in contextual influences (e.g., action contexts such as racism and homophobia; self-regulatory resources such as substance use), self-change processes (e.g., social interaction processes including social networks; motivational appraisals), and action states (e.g., attendance at HIV care appointments, substance use treatment [as needed], ART re-initiation). The study’s primary outcome is HIV viral suppression (VS). Two interconnected aims are proposed: to describe trajectories of engagement along the HCC (Aim 1), and guided by Social Action Theory, to identify, describe, and understand the contextual influences, self-change processes, and action states that impede or support the behaviors that comprise engagement along the HCC over time, including YEA-LWH’s perspectives on these factors (Aim 2). A Youth Advisory Board will be joined by scientific advisors to develop actionable recommendations based on study findings, which will be disseminated. Participants (N=270, half with HIV VS and half non-suppressed at enrollment) will be diverse African American/Black or Latinx behaviorally infected YEA-LWH recruited in New York City and Newark, NJ using a proven hybrid strategy. We will follow participants prospectively for 18 months using mixed methods, combining baseline and follow-up data (N ≈ 810 viral load observations), to assess the multifaceted domains expected to facilitate or impede engagement along the HCC, and YEA-LWH’s perspectives on their causes and meanings. The research team is expert in longitudinal mixed methods studies, HCC research, and AABL YEA. The proposed study aligns with NIH priorities and will advance solutions for this serious public health problem.

项目摘要：处于青春期至青春期发育阶段的艾滋病毒感染者 (LWH) 的年轻人 新兴成年期（16-28 岁），我们称为“青年和新兴成人”(YEA)，具有 在所有年龄组中，艾滋病毒护理连续体 (HCC) 的参与率最低。 对于非裔美国人/黑人和拉丁裔 YEA-LWH 最为明显，包括性/性别少数群体， 然而，我们对酗酒/吸毒的人以及社会经济地位较低的人的了解。 促进或阻碍 HCC 参与的因素，以及它们随着时间的推移如何运作和相互作用， 对于有限发生的行为（例如，艾滋病毒护理预约）和重复发生的行为来说，这是不够的 这些差距限制了政策和卫生服务的创新。 前瞻性纵向研究使用混合方法，重点关注非裔美国人/黑人和拉丁裔 YEA- 该研究使用定量、定性、生物标志物（HIV 病毒）。 负荷、药物使用）和生态瞬时评估方法来发现、描述和更好地 准确地了解随着时间的推移，影响 HCC 参与轨迹的因素， 包括从 YEA-LWH 的角度来看，这项研究以社会行动理论为基础，这是一种综合性的理论。 社会认知/生态模型，允许检查情境影响的变化（例如，行动 种族主义和恐同症等背景；自我监管资源（如药物使用）、自我改变 过程（例如，社会互动过程，包括社交网络；动机评估）和行动 州（例如，参加艾滋病毒护理预约、[根据需要]药物使用治疗、重新启动 ART）。 该研究的主要结果是抑制 HIV 病毒（VS），提出了两个相互关联的目标： 描述 HCC 的参与轨迹（目标 1），并以社会行动理论为指导，以确定、 描述并理解阻碍或阻碍的情境影响、自我改变过程和行动状态 随着时间的推移，支持参与 HCC 的行为，包括 YEA-LWH 的 科学顾问将加入青年咨询委员会以制定对这些因素的看法（目标 2）。 基于研究结果的可行建议将被分发给参与者（N=270，一半）。 HIV VS 和一半在入学时未受抑制）将是多样化的非裔美国人/黑人或拉丁裔 我们使用经过验证的混合策略在纽约市和新泽西州纽瓦克招募了行为感染的 YEA-LWH。 将使用混合方法，结合基线和随访，前瞻性地跟踪参与者 18 个月 数据（N ≈ 810 个病毒载量观察值），以评估预期促进或阻碍的多方面领域 HCC 的参与，以及 YEA-LWH 对其原因和意义的看法。 是纵向混合方法研究、HCC 研究和 AABL YEA 方面的专家。 与 NIH 的优先事项相一致，并将推动这一严重公共卫生问题的解决方案。