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：从青春期到的发展期，年轻人患有艾滋病毒（LWH）（LWH） 新兴的成年（16-28岁），我们称为“青年和新兴成年人”（是的） 任何年龄段的艾滋病毒护理连续体（HCC）的参与率最低。这种不良的参与是 对于非裔美国人/黑人和拉丁裔Yea-Wh，包括性/性别少数群体，最明显的是 使用酒精/药物以及来自低社会经济地位背景的个人。但是，我们对 促进或阻碍沿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的因素是 对于有限的发生行为（例如，艾滋病毒护理约会）和重复发生的情况不足 行为（例如艺术依从性）。这些差距将创新限制为政策和卫生服务。提议 前瞻性纵向研究采用混合方法，并专注于非裔美国人/黑人和拉丁裔Yea- LWH具有和没有病毒抑制的情况。该研究使用定量，定性，生物标志物（HIV病毒） 负载，吸毒）和生态瞬时评估方法，以发现，描述和更好 了解随着时间的流逝，有助于沿HCC参与轨迹的因素，精确， 包括从Yea-LWH的角度来看。该研究基于社会行动理论，这是一个综合 社会认知/生态模型，可以检查上下文影响的变化（例如行动 种族主义和同性恋恐惧症等环境；自我调节资源，例如使用物质），自我改变 流程（例如，包括社交网络在内的社会互动过程；动机评估）和行动 各州（例如，参加艾滋病毒护理任命，药物使用治疗[根据需要]，艺术重新生效）。 该研究的主要结果是HIV病毒抑制（VS）。提出了两个相互联系的目标： 描述沿HCC（目标1）的参与轨迹，并在社会行动理论的指导下，以识别， 描述并理解阻碍或 支持随着时间的流逝，包括Yea-LWH的行为 对这些因素的观点（AIM 2）。科学顾问将加入一个青年顾问委员会 基于研究结果的可行建议，这些建议将被传播。参与者（n = 270，一半 艾滋病毒vs和一半的入学人数）将是非裔美国人/黑人或拉丁裔 在纽约市和新泽西州纽瓦克招募的行为感染的Yea-LWH使用良好的混合策略。我们 将使用混合方法前瞻性地关注参与者18个月，结合基线和随访 数据（n≈810个病毒载荷观测值），以评估预期有助于或阻碍的多方面域 沿HCC的参与以及Yea-LWH对他们的原因和含义的看法。研究团队 是纵向混合方法研究，HCC研究和Aabl Yea的专家。拟议的研究对齐 有了NIH的优先事项，将为这个严重的公共卫生问题提高解决方案。