Obstetrics, Gynecology and Reproductive Sciences, Division of Research and Special Projects, University of Miami Miller School of Medicine, Miami, FL, United States.
Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecologic Oncology, University of Miami Miller School of Medicine, Miami, FL, United States.
Front Public Health. 2021 Jun 21;9:667331. doi: 10.3389/fpubh.2021.667331. eCollection 2021.
Ending HIV/AIDS in the United States requires tailored interventions. This study is part of a larger investigation to design mCARES, a mobile technology-based, adherence intervention for ethnic minority women with HIV (MWH). To understand barriers and facilitators of care adherence (treatment and appointment) for ethnic MWH; examine the relationship between these factors across three ethnic groups; and, explore the role of mobile technologies in care adherence. Cross-sectional, mixed-methods data were collected from a cohort of African-American, Hispanic-American and Haitian-American participants. Qualitative data were collected through a focus group ( = 8) to assess barriers and facilitators to care adherence. Quantitative data ( = 48) surveyed women on depressive symptomology (PHQ-9), HIV-related stigma (HSS) and resiliency (CD-RISC25). We examined the relationships between these factors and adherence to treatment and care and across groups. Qualitative analyses revealed that barriers to treatment and appointment adherence were caregiver-related stressors (25%) and structural issues (25%); routinization (30%) and religion/spirituality (30%) promoted adherence to treatment and care. Caregiver role was both a hindrance (25%) and promoter (20%) of adherence to treatment and appointments. Quantitatively, HIV-related stigma differed by ethnic group; Haitian-Americans endorsed the highest levels while African-Americans endorsed the lowest. Depression correlated to stigma ( = 0.534; < 0.001) and resiliency ( = -0.486; < 0.001). Across ethnic groups, higher depressive symptomology and stigma were related to viral non-suppression ( < 0.05)-a treatment adherence marker; higher resiliency was related to viral suppression. Among Hispanic-Americans, viral non-suppression was related to depression ( < 0.05), and among African-Americans, viral suppression was related to increased resiliency ( < 0.04). Multiple interrelated barriers to adherence were identified. These findings on ethnic group-specific differences underscore the importance of implementing culturally-competent interventions. While privacy and confidentiality were of concern, participants suggested additional intervention features and endorsed the use of mCARES as a strategy to improve adherence to treatment and appointments.
在美国终结艾滋病需要有针对性的干预措施。本研究是设计基于移动技术的 mCARES 项目的一部分，该项目旨在为感染艾滋病毒的少数族裔女性（MWH）提供帮助。为了了解少数民族感染艾滋病毒的女性（MWH）在治疗和预约方面的坚持情况的障碍和促进因素；考察这些因素在三个族裔群体中的关系；并探讨移动技术在坚持治疗和预约方面的作用。采用横断面混合方法，从非裔美国女性、西班牙裔美国女性和海地裔美国女性参与者的队列中收集了数据。通过焦点小组（ = 8）收集定性数据，以评估坚持治疗和预约的障碍和促进因素。对 48 名女性进行了问卷调查，以评估抑郁症状（PHQ-9）、艾滋病毒相关耻辱感（HSS）和恢复力（CD-RISC25）。我们考察了这些因素与治疗和护理坚持情况之间以及群体之间的关系。定性分析表明，治疗和预约坚持的障碍包括照顾者相关的压力源（25%）和结构性问题（25%）；常规化（30%）和宗教/精神信仰（30%）促进了治疗和护理的坚持。照顾者的角色既是治疗和预约坚持的障碍（25%），也是促进因素（20%）。定量分析表明，艾滋病毒相关耻辱感因族裔群体而异；海地裔美国人的认同度最高，而非洲裔美国人的认同度最低。抑郁与耻辱感（ = 0.534； < 0.001）和恢复力（ = -0.486； < 0.001）相关。在所有族裔群体中，较高的抑郁症状和耻辱感与病毒未抑制（ < 0.05）——一种治疗坚持的标志物有关；较高的恢复力与病毒抑制有关。在西班牙裔美国人中，病毒未抑制与抑郁有关（ < 0.05），而在非洲裔美国人中，病毒抑制与恢复力增加有关（ < 0.04）。确定了多个相互关联的坚持障碍。这些关于族裔群体差异的发现强调了实施文化上兼容的干预措施的重要性。虽然隐私和保密性是关注的问题，但参与者提出了额外的干预措施，并认可使用 mCARES 作为提高治疗和预约坚持的策略。
