Disparities in the HIV Care Continuum among Hispanics in the United States

美国西班牙裔人群艾滋病毒护理连续性的差异

• 批准号: 9136350
• 负责人: Fidel Desir Boya
• 金额: $ 4.86万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9136350
• 关键词: AIDS prevention; AIDS/HIV problem; Accounting; Acculturation; Acquired Immunodeficiency Syndrome; Address; Adult; Affect; Alcohol consumption; American; Area; Baltimore; Behavioral; Benchmarking; Caring; Cities; Clinic; Clinical; Collaborations; Complex; Continuity of Patient Care; Data; Data Sources; Demographic Factors; Development; Diagnosis; Disease Progression; Epidemic; Ethnic group; Event; Face; Failure; Goals; HIV; HIV Infections; HIV diagnosis; Health; Health Insurance; High Prevalence; Hispanics; Incidence; Individual; Infection; Institute of Medicine (U.S.); Intervention; Interview; Language; Link; Longevity; Measures; Medical; Monitor; Nature; Not Hispanic or Latino; Outcome; Persons; Population; Population Attributable Risks; Population Intervention; Positioning Attribute; Preventive Intervention; Qualitative Research; Race; Reporting; Research; Research Design; Research Methodology; Risk; Risk Factors; Source; Staging; Substance abuse problem; Time; United States; Update; Viral; antiretroviral therapy; base; clinical care; cohort; design; experience; health disparity; high risk; improved; prevent; public health intervention; public health relevance; racial and ethnic; therapy design; time use; transmission process; trend

 DESCRIPTION (provided by applicant): The HIV epidemic has disproportionately affected the Hispanic population in the United States (US). Hispanics face the second-highest prevalence and incidence rates of HIV. Hispanics are also more likely to receive HIV care at later stages of HIV disease progression relative to any other racial or ethnic group. A complex set of unique individual- and structural-level factors confront this population and contribute to the burden of health disparities in HIV care and treatment experienced by Hispanics. In 2015, the National HIV/AIDS Strategy for the United States: Updated to 2020 (NHAS) set forth goals to reduce HIV-related disparities in high-risk populations, such as Hispanics, and to increase the proportion of individuals successfully engaged at all levels of the spectrum of HIV care and treatment. This spectrum, termed the HIV care continuum (HIVCC), has become a high-priority area for intervention. Increasing the proportions of HIV-infected individuals who progress through and ultimately reach the last stage of the HIVCC (viral suppression) has been shown to prevent over 90% of new HIV infections. To address the Hispanic population's unique HIV-related needs, it is critical to monitor trends in HIV care indicators for improvement over time and to identify the factors underlying HIV care in this population for the development of tailored public health interventions. We aim to: 1) estimate trends in the proportion of adult Hispanics that were in the last three steps of the HIVCC (retention in HIV care, prescription of antiretrovirl therapy [ART], and viral suppression) from 2004 to 2014; 2) identify demographic factors and behavioral targets for interventions to improve retention in HIV care, ART use, and viral suppression among Hispanic adults in HIV care in the US; and 3) explore the nature of progression through the last three steps of the HIVCC among adult Hispanics and identify the structural-level barriers and facilitators influencing this progression using qualitative research methods. For Aims 1 and 2, we will use data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). The NA-ACCORD offers the largest-available source of longitudinal data on HIV- infected Hispanics (>15,000) in the US and has been endorsed by the Institute of Medicine as an appropriate data source for monitoring progress in NHAS goals. We will conduct qualitative in-depth interviews (N=25) with HIV-infected Hispanics in Baltimore City in Aim 3 to obtain a rich, complementary understanding of structural- level factors influencing HIVCC proportions among Hispanics. The results of this research will inform strategies designed to achieve NHAS goals to reduce health disparities and improve HIV care among Hispanics.

 描述（由申请人提供）：艾滋病毒流行对美国的西班牙裔人口造成了不成比例的影响，西班牙裔人口的艾滋病毒患病率和发病率位居第二，也更有可能在后期接受艾滋病毒护理。与任何其他种族或族裔群体相比，该人群面临着一系列复杂的独特的个人和结构层面的因素，并导致西班牙裔人在艾滋病毒护理和治疗方面承受着健康差异的负担。美国艾滋病毒/艾滋病战略：更新至 2020 年 (NHAS) 制定了减少西班牙裔等高危人群中与艾滋病毒相关的差异的目标，并增加成功参与各个级别的个人比例艾滋病毒护理和治疗。这一范围被称为艾滋病毒护理连续体（HIVCC），已成为一个高度优先的干预领域，以提高艾滋病毒感染者进展并最终到达最后阶段的比例。 HIVCC（病毒抑制）已被证明可以预防 90% 以上的新发 HIV 感染。为了满足西班牙裔人群独特的 HIV 相关需求，监测 HIV 护理指标随时间的改善趋势并确定 HIV 的潜在因素至关重要。我们的目标是：1) 估计处于 HIVCC 最后三个阶段的成年西班牙裔人口的比例趋势（保留艾滋病毒护理、抗逆转录病毒治疗处方 [ART]）。 ，以及病毒式传播抑制）从 2004 年到 2014 年；2）确定干预措施的人口因素和行为目标，以改善美国艾滋病毒护理中西班牙裔成年人的艾滋病毒护理保留率、抗逆转录病毒治疗的使用和抑制病毒；3）探索通过成年西班牙裔艾滋病病毒感染者的最后三个步骤，并使用定性研究方法确定影响这一进展的结构层面的障碍和促进因素。对于目标 1 和 2，我们将使用来自北美艾滋病队列合作的数据。研究与设计 (NA-ACCORD) 提供美国艾滋病毒感染者 (>15,000) 的最大可用纵向数据源，并已被医学研究所认可为适当的数据源。监测 NHAS 目标的进展情况。我们将在目标 3 中对巴尔的摩市的 HIV 感染者进行定性深入访谈 (N=25)，以获得对影响 HIVCC 比例的结构层面因素的丰富、互补的了解。西班牙裔美国人。这项研究的结果将为旨在实现 NHAS 目标的战略提供信息，以减少西班牙裔美国人的健康差距和改善艾滋病毒护理。