Addressing Trauma from Interpersonal Violence through a Web-based Peer Navigation-Social Support Intervention to Improve ART Adherence among Women

通过基于网络的同伴导航-社会支持干预来解决人际暴力造成的创伤，以提高妇女对 ART 的依从性

• 批准号: 10275346
• 负责人: Jamila Kinshasa Stockman
• 金额: $ 79.85万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10275346
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Adult; Affect; Affective; California; Caring; Clinic; Collection; Color; Continuity of Patient Care; County; Distress; Effectiveness; Emotions; Enrollment; Epidemic; Goals; HIV; Hair; Individual; Interpersonal Violence; Intervention; Link; Mediator of activation protein; Medical; Mental Depression; Mental Health; Methods; Moods; Online Systems; Outcome; Participant; Pathway interactions; Personal Satisfaction; Persons; Population; Post-Traumatic Stress Disorders; Proliferating; Randomized; Randomized Controlled Trials; Recording of previous events; Research; Resources; Sampling; Self Care; Self Efficacy; Services; Sexual abuse; Social support; Structure; Substance Use Disorder; Substance abuse problem; Support Groups; Surveys; Symptoms; Technology; Testing; Transportation; Trauma; Treatment outcome; Triad Acrylic Resin; Violence; Viral; Woman; antiretroviral therapy; arm; base; cis-female; coping; efficacy evaluation; emotion regulation; emotional abuse; experience; follow up assessment; implementation cost; implementation intervention; improved; intimate partner violence; men; new technology; peer; physical abuse; preventive intervention; programs; psychoeducation; psychologic; recruit; skills; social stigma; social structure; substance use; theories; therapy adherence; therapy design; transgender women; trauma exposure; treatment arm; violence exposure; web site

PROJECT SUMMARY In the US, women living with HIV/AIDS (WLHA) are less likely to be adherent to antiretroviral therapy (ART) and virally suppressed compared to men living with HIV/AIDS. Concurrently, WLHA experience high rates of interpersonal violence – physical, sexual, and/or psychological abuse in adulthood – which often results in trauma (e.g., post-traumatic stress disorder [PTSD]) and other adverse mental health, further contributing to ART non-adherence. Additionally, the confluence of syndemic adverse mental health, substance use, and socio-structural factors (e.g., HIV stigma, medical mistrust) further contribute to poor HIV outcomes. Social support through peer navigation and networks has been shown to counter these effects and improve HIV outcomes among WLHA. Likewise, psychoeducation addressing affective distress to improve mood and emotion management and relationship skills has been shown to reduce PTSD and depression. However, limited resources at HIV service agencies combined with socio-structural barriers (e.g., lack of transportation, competing priorities) impede the potential effectiveness of in-person peer navigation. A scalable and sustainable solution is the use of technology in the form of web-based video interaction. To that end, we developed and pilot tested a 4-month web-based, trauma-informed peer navigation-psychoeducation social support intervention among WLHA affected by interpersonal violence and syndemic adverse mental health and/or substance use. We demonstrated feasibility, acceptability, preliminary improvements in ART adherence, PTSD symptoms, coping self-efficacy, and social support. Building on these promising pilot findings, we propose to conduct a randomized controlled trial of Women SHINE to improve ART adherence among WLHA affected by adulthood interpersonal violence in California. Participants will be randomized to either: a) the intervention arm (n=180) where women will receive a 4-month program comprised of video-based peer navigation support via one-on-one sessions and 7 psychoeducation weekly support group sessions, and access to a static Women SHINE website with statewide resources for HIV care, interpersonal violence, trauma, mental health, and substance use; or b) the control arm (n=180) where women will receive a single group session on self-care and well-being, with access to the static Women SHINE website. Women will complete video-based survey assessments and mailed hair sample self-collection at baseline, 4-, 8-, and 12- months post-randomization. Compared to the control arm, we will determine if Women SHINE is associated with improvements in ART adherence (Aim 1) and PTSD symptoms and emotion regulation (Aim 2). We will also examine individual (e.g., self-efficacy for coping, social support networks) and socio-structural (e.g., HIV stigma, medical mistrust) mechanisms of change in the efficacy of Women SHINE (Aim 3). If efficacious, we will conduct subsequent research to determine effective and feasible methods for intervention implementation nationwide to improve HIV outcomes among WLHA.

项目摘要 在美国，患有艾滋病毒/艾滋病（WLHA）的妇女不太可能遵守抗逆转录病毒疗法（ART） 与患有艾滋病毒/艾滋病的男性相比，病毒受到抑制。同时，WLHA经历了高度的 人际暴力 - 成年后的身体，性和/或心理虐待 - 通常会导致 创伤（例如创伤后应激障碍[PTSD]）和其他不良心理健康，进一步有助于 艺术不遵守。此外，集团不良心理健康，药物使用和 社会结构因素（例如，艾滋病毒污名，医学不信任）进一步导致了艾滋病毒不良的结果。社会的 通过同行导航和网络的支持已被证明可以应对这些影响并改善HIV WLHA中的结果。同样，心理教育解决情感困扰以改善情绪和 情绪管理和人际关系技巧已被证明可以减少PTSD和抑郁症。然而， 艾滋病毒服务机构的资源有限，结合了社会结构障碍（例如，缺乏运输， 竞争优先级）阻碍了面对面同行导航的潜在有效性。可扩展和 可持续解决方案是以基于Web的视频交互形式使用技术。为此，我们 开发和飞行员测试了一个基于4个月的基于创伤的同伴导航 - 精神教育社会 受到人际关系暴力和辛迪克不利心理健康影响的WLHA的支持干预 和/或使用物质。我们证明了可行性，可接受性，艺术依从性的初步改善， PTSD症状，应对自我效能感和社会支持。在这些有希望的飞行员发现的基础上，我们 提议对妇女进行随机对照试验，以提高WLHA的艺术依从性 受到加利福尼亚州成年的人际暴力的影响。参与者将被随机分配给：a） 干预部门（n = 180），女性将获得一个为基于视频的同伴完成的4个月计划 通过一对一会议和7个心理教育每周支持小组会议的导航支持，以及 访问静态女性Shine网站，具有全州范围内的艾滋病毒护理资源，人际关系暴力， 创伤，心理健康和药物使用；或b）控制臂（n = 180），女性将获得一个 关于自我保健和福祉的小组会议，并访问了静态女性Shine网站。女人会 基线，4-，8和12-的完整基于视频的调查评估和邮寄头发样本自收集 随机后几个月。与控制臂相比，我们将确定女性是否相关 随着艺术依从性的改善（AIM 1）和PTSD症状和情绪调节（AIM 2）。我们将 还要检查个人（例如，应对的自我效能感，社会支持网络）和社会结构（例如，艾滋病毒 污名，医学不信任）女性效率变化的机制（AIM 3）。如果有效，我们 将进行随后的研究，以确定实施干预的有效和可行方法 在全国范围内改善WLHA中的HIV结果。