亚特兰大感染艾滋病毒的男男性行为者中黑人和白人之间护理结果的差异：一项前瞻性队列研究（参与[男性]）方案

Disparities in Care Outcomes in Atlanta Between Black and White Men Who Have Sex With Men Living With HIV: Protocol for a Prospective Cohort Study (Engage[men]t).

作者信息

Sullivan Patrick Sean, Taussig Jennifer, Valentine-Graves Mariah, Luisi Nicole, Del Rio Carlos, Guest Jodie L, Jones Jeb, Millett Greg, Rosenberg Eli S, Stephenson Rob, Kelley Colleen

机构信息

Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.

Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, United States.

出版信息

JMIR Res Protoc. 2021 Feb 23;10(2):e21985. doi: 10.2196/21985.

DOI:10.2196/21985

PMID:33320821

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7943338/

Abstract

BACKGROUND

The US HIV epidemic is driven by infections in men who have sex with men and characterized by profound disparities in HIV prevalence and outcomes for Black Americans. Black men who have sex with men living with HIV are reported to have worse care outcomes than other men who have sex with men, but the reasons for these health inequities are not clear. We planned a prospective observational cohort study to help understand the reasons for worse HIV care outcomes for Black versus White men who have sex with men in Atlanta.

OBJECTIVE

The aim of this study is to identify individual, dyadic, network, neighborhood, and structural factors that explain disparities in HIV viral suppression between Black and White men who have sex with men living with HIV in Atlanta.

METHODS

Black and White men who have sex with men living with HIV were enrolled in a prospective cohort study with in-person visits and viral suppression assessments at baseline, 12 months, and 24 months; additional surveys of care and risk behaviors at 3, 6, and 18 months; analysis of care received outside the study through public health reporting; and qualitative interviews for participants who experienced sentinel health events (eg, loss of viral suppression) during the study. The study is based on the Bronfenbrenner socioecological theoretical model.

RESULTS

Men who have sex with men (n=400) were enrolled between June 2016 and June 2017 in Atlanta. Follow-up was completed in June 2019; final study retention was 80% at 24 months.

CONCLUSIONS

Health disparities for Black men who have sex with men are hypothesized to be driven by structural racism and barriers to care. Observational studies are important to document and quantify the specific factors within the socioecological framework that account for disparities in viral suppression. In the meantime, it is also critical to push for steps to improve access to care, including Medicaid expansion in Southern states, such as Georgia, which have not yet moved to expand Medicaid.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/21985.

摘要

背景

美国的艾滋病病毒流行由男男性行为者中的感染所驱动，其特点是美国黑人在艾滋病病毒流行率和治疗结果方面存在巨大差异。据报道，感染艾滋病病毒的男男性行为黑人的治疗结果比其他男男性行为者更差，但这些健康不平等的原因尚不清楚。我们计划开展一项前瞻性观察队列研究，以帮助了解亚特兰大感染艾滋病病毒的男男性行为黑人与白人相比治疗结果更差的原因。

目的

本研究的目的是确定个体、二元、网络、社区和结构因素，这些因素可解释亚特兰大感染艾滋病病毒的男男性行为黑人与白人在艾滋病病毒抑制方面的差异。

方法

感染艾滋病病毒的男男性行为黑人和白人参加了一项前瞻性队列研究，在基线、12个月和24个月进行面对面访视和病毒抑制评估；在3个月、6个月和18个月对护理和风险行为进行额外调查；通过公共卫生报告分析研究外接受的护理；对在研究期间经历哨兵健康事件（如病毒抑制丧失）的参与者进行定性访谈。该研究基于布朗芬布伦纳社会生态理论模型。