Engagement in Care and Emotional Support in the Context of Interpersonal Trauma: A Mixed -Methods Investiigation

Johns Hopkins University, Baltimore MD

Investigators

Abstract

HIV treatment and prevention are essential to reducing healthcare-related expenditures and promoting and the health of the US population. Although comprising approximately 9.5% of the US population, Latino men account for more than a quarter of all new HIV diagnoses in the United States. People living with HIV (PLWH) are at risk for exposure to interpersonal trauma (IT) and among Latinos living with HIV, male immigrants face increased risk of IT related to their HIV status and immigration journeys. IT has been shown to adversely impact victims’ biopsychosocial and emotional health and has been associated with poor health outcomes such as mental illness and poor engagement in care (EIC) among people living with HIV (PLWH). Latino men are disproportionately impacted by HIV, and EIC-related outcomes such as retention in care among Latinos are well below US and international goals. Latino PLWH also have low engagement in mental health care and are at risk for low emotional support (ES)—a protective resource shown to buffer the negative psychosocial, emotional, and behavioral impacts of IT. Unfortunately, little is known about the impact of IT on EIC among Latino immigrant men living with HIV (LIMWH) and the protective psychosocial resources that influence EIC among LIMWH in the context of IT. To better understand these relationships among LIMWH and inform HIV prevention and treatment, this study will utilize the recent Patient Health Engagement (PHE) model describing psychological and emotional processes involved in EIC. The purpose of this exploratory sequential mixed methods study is to generate a rich understanding of the experiences of LIMWH with EIC and IT and the psychosocial resources that HIV care teams can promote to improve EIC and psychosocial well-being among LIMWH by addressing the following specific aims: Aim 1a: Understand the experiences of LIMWH (n=20) with IT and the psychosocial and emotional influences that impact their EIC. Aim 1b: Understand the perspectives of HIV care team members (n=15) caring for LIMWH regarding the impact of IT and psychosocial and emotional influences on EIC in this population. Aim: 2: Examine the association between exposure to IT on the continuum of EIC among LIMWH (n=100) while controlling for individual and interpersonal covariates. Aim 3: Evaluate the association between ES and the continuum of EIC among LIMWH while controlling for individual and interpersonal covariates. The proposed study will use preliminary results from semi-structured qualitative interviews with LIMWH and HIV care providers from the Baltimore-Washington metro area to inform a quantitative survey assessing the associations between IT, EIC and ES. Reflexive Thematic Analysis (RTA) will be used to analyze qualitative interview data and identify themes and key psychosocial variables to be included in the survey and subsequent analysis using multivariable logistic regression models, model testing, and subgroup analysis. This iterative approach incorporating the perspectives of LIMWH and HIV providers will strengthen the validity of the findings and inform future research and psychosocial interventions among LIMWH to promote optimal EIC, psychosocial wellbeing, and progress towards Ending the HIV Epidemic.