Examining Social Determinants of Antiretroviral Adherence Trajectories among African American Adults with HIV

检查非洲裔美国成人艾滋病毒感染者抗逆转录病毒药物依从轨迹的社会决定因素

• 批准号: 10700611
• 负责人: Vanessa Bianca Serrano
• 金额: $ 4万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700611
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adult; Affect; African American; African American population; Anti-Retroviral Agents; Behavioral Medicine; Black Populations; Black race; California; Caring; Characteristics; Classification; Communities; Community Healthcare; Continuity of Patient Care; Data; Dedications; Descriptor; Development; Disease Outcome; Epidemic; Evidence based intervention; Face; Fellowship; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV/AIDS; Health; Individual; Intervention; Longevity; Medical; Mental Health; Outcome; Pattern; Persons; Population; Population Heterogeneity; Psychosocial Influences; Public Health; Qualitative Research; Reporting; Research; Research Methodology; Research Personnel; Risk; Role; Self Efficacy; Severity of illness; Social support; Strategic Planning; Subgroup; Text Messaging; Time; United States; Viral; Viral Load result; adherence rate; antiretroviral therapy; cohesion; experience; follow-up; health care availability; health care service utilization; health determinants; health disparity; health management; health related quality of life; improved; medication compliance; physical conditioning; poor health outcome; psychosocial; psychosocial resources; regional difference; resilience; scale up; social determinants; social stigma; text messaging intervention; therapy adherence; two way texting

PROJECT SUMMARY/ABSTRACT Despite the scaling up of evidence-based interventions to End the HIV Epidemic (EHE) in the U.S., several communities most affected by HIV lag behind the EHE goal of reducing HIV infections by 90% by 2030. Black/African American (AA) people with HIV (PWH) account for a large proportion of HIV diagnoses in the U.S. Specifically, AAs represented 42% of all new HIV diagnoses reported in 2019 despite comprising only 13% of the total United States population. Furthermore, AA PWH have poorer outcomes along the entire HIV care continuum, including a greater number with undiagnosed HIV, poorer linkage to and retention in HIV care, lower rates of receiving antiretroviral therapy (ART), lower ART adherence rates, and lower likelihood of achieving viral suppression. While AA PWH with strong community cohesion report positive HIV outcomes (e.g., high ART adherence, viral suppression), in regions where there is low community cohesion among AA PWH, these individuals may be overlooked, despite the unique experience of having weaker community cohesion. As such, it is imperative to focus research efforts on investigating psychosocial determinants of health among AA PWH with low community cohesion. We have shown that high psychosocial resources (e.g., resilience, personal mastery, social support) positively influences health outcomes such as medication adherence, and physical and mental health-related quality of life. Nevertheless, these quantitative-based studies may not account for the unique, individual experiences of AA PWH who lack strong community cohesion. Assessing the relationships between psychosocial determinants of health, medication adherence, and healthcare utilization is critical toward identifying AA PWH most at-risk for poor health outcomes. Accordingly, the proposed F31 project will follow-up on an initial study of AA PWH in order to: 1) Characterize ART adherence trajectories and their associations with HIV characteristics among AA PWH in an EHE jurisdiction with low AA community cohesion; 2) Identify modifiable psychosocial determinants of health associated with ART adherence trajectories among AA PWH in an EHE jurisdiction with low AA community cohesion; and 3) Explore qualitative relationships between positive modifiable psychosocial determinants of health (e.g., resilience), ART adherence, and healthcare utilization among AA PWH in an EHE jurisdiction with low AA community cohesion. The proposed research will use advanced qualitative and quantitative research methods to examine these relationships. The opportunities afforded via this F31 mechanism will facilitate the applicant’s professional development toward becoming an independent investigator dedicated to researching behavioral medicine topics such as psychosocial determinants of health outcomes among diverse populations.

项目概要/摘要 尽管在美国扩大了基于证据的干预措施以结束艾滋病毒流行（EHE），但一些 受艾滋病毒影响最严重的社区落后于 EHE 到 2030 年将艾滋病毒感染率减少 90% 的目标。 黑人/非裔美国人 (AA) 艾滋病毒感染者 (PWH) 占艾滋病毒诊断的很大一部分 具体而言，在美国，2019 年报告的所有新 HIV 诊断中 AA 占 42%，尽管仅包括 占美国总人口的 13% 此外，AA PWH 的整个 HIV 治疗结果较差。 护理连续性，包括更多人未确诊艾滋病毒、与艾滋病毒护理的联系和保留较差， 接受抗逆转录病毒治疗 (ART) 的比率较低，ART 依从率较低，并且发生这种情况的可能性较低 具有强大社区凝聚力的 AA PWH 报告了积极的艾滋病毒结果。 （例如，高 ART 依从性、病毒抑制），在 AA 之间社区凝聚力较低的地区 PWH，这些人可能会被忽视，尽管他们有社区较弱的独特经历 因此，必须将研究重点放在调查社会心理决定因素上。 社区凝聚力较低的 AA PWH 的健康状况 我们已经表明，社会心理资源较高。 （例如，适应力、个人掌控力、社会支持）对健康结果（例如药物治疗）产生积极影响 尽管如此，这些还是与身心健康相关的生活质量。 研究可能无法解释缺乏强大社区的 AA PWH 的独特个人经历 评估健康的心理社会决定因素、药物依从性和 医疗保健利用对于确定 AA PWH 健康状况不佳的风险至关重要。 拟议的 F31 项目将跟进 AA PWH 的初步研究，以便： 1) 描述 ART 依从性 在 AA 较低的 EHE 辖区内 AA PWH 的轨迹及其与 HIV 特征的关联 社区凝聚力；2) 确定与 ART 相关的可改变的健康社会心理决定因素 AA 社区凝聚力较低的 EHE 辖区内 AA PWH 的遵守轨迹；以及 3) 探索健康的积极可改变的心理社会决定因素之间的定性关系（例如， 在 AA 较低的 EHE 管辖区中，AA PWH 的 ART 依从性和医疗保健利用率 拟议的研究将使用先进的定性和定量研究方法。 通过此 F31 机制提供的机会将有利于申请人。 成为一名致力于研究行为的独立调查员的专业发展 医学主题，例如不同人群健康结果的社会心理决定因素。