Defining intervention targets along pathways from cumulative stress and trauma to alcohol and HIV self-management among young people living with HIV (Project DEFINE)

沿着从累积压力和创伤到青少年艾滋病毒感染者酒精和艾滋病毒自我管理的路径确定干预目标（项目定义）

• 批准号: 10304697
• 负责人: SHARON L NICHOLS
• 金额: $ 11.3万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10304697
• 关键词: Address; Age; Alcohol abuse; Alcohol consumption; Alcohols; Behavior; Behavioral; Behavioral Sciences; Cannabis; Caring; Characteristics; Chronic; Collaborations; Communities; Complex; Critical Care; Cultural Characteristics; Decision Making; Development; Discrimination; Disease; Disease Management; Education; Emotions; Enrollment; Ensure; Ethnic Origin; Failure; Gender; Gender Identity; Goals; HIV; HIV Seronegativity; Health; Individual; Intervention; Link; Longevity; Longitudinal cohort study; Measures; Mediating; Mental Health; Methods; Minority; Modeling; Outcome; Participant; Pathway interactions; Play; Population; Prevention; Quality of life; Race; Regulation; Role; Self Management; Sleep; Sleep Disorders; Source; Stress; Structure; Surveys; Trauma; United States National Institutes of Health; Viral; Viral Load result; Vulnerable Populations; Youth; alcohol comorbidity; biological sex; childhood adversity; cognitive function; community engagement; diaries; emerging adult; emotion regulation; ethnic identity; ethnic minority population; experience; hazardous drinking; high risk; improved; innovation; intersectionality; knowledge of results; member; microaggression; outreach; perceived stress; poor sleep; programs; racial and ethnic; racial identity; racial minority; screening; sexual identity; sexual minority; sleep health; social stigma; stress management; stress symptom; substance use; success; therapy development; tool; transgender; trauma exposure; traumatic stress

1 Young people living with HIV (YPLWH) are at high risk for poor HIV self-management, with 2 detectable viral load in 88%, and for hazardous alcohol use which can negatively impact the HIV 3 treatment and prevention cascade. Interventions to improve self-management of both alcohol 4 use and HIV care are critical but have had limited success in part due to the failure to account 5 for developmental and cultural characteristics unique to this population and stress and trauma 6 conferred by these characteristics. YPLWH are disproportionately racial, ethnic and sexual 7 minorities who experience higher rates of chronic and complex sources of stress and trauma 8 throughout their lives. Additionally, there are oppressive sources of stress and trauma related to 9 their racial, ethnic, sexual, and gender identities and HIV status, such as discrimination, 10 microaggressions, and stigma as a result of systemic structural and societal inequities. Although 11 stress has been linked to alcohol use and disease management, the pathways underlying these 12 links among YPLWH are poorly understood. Evidence suggests several modifiable factors that 13 may play a role in these indirect pathways. Stress has been associated with poor sleep health, 14 which may impact alcohol use and HIV self-management through the effect that poor sleep has 15 on emotion regulation. Behavioral regulation (e.g., decision-making, inhibitory control), is a core 16 component of self-management and may similarly mediate associations between cumulative 17 stress and alcohol use. Consistent with the overall goal of the P01 to improve self-management 18 of alcohol use and HIV care among YPLWH, this project would define developmentally and 19 culturally relevant, modifiable intervention targets in causal pathways between cumulative stress 20 and self-management outcomes among YPLWH, most of whom are subject to intersectional 21 sources of stress and trauma. Using innovative outreach methods, we will enroll 300 diverse 22 YPLWH age 18-29 to complete surveys of cumulative and intercurrent stress and trauma, sleep 23 health (i.e., survey and ecological momentary analysis [EMA] using an electronic sleep diary), 24 emotion and behavioral regulation, and substance use and HIV outcomes at baseline, 9 and 18 25 months. Further, minority YPLWH are less likely to be screened for or have access to available 26 interventions. In the fifth year, we will use a mixed methods approach in collaboration with 27 community members to develop a toolkit of adapted scalable measures for intervention 28 targeting. The resulting knowledge and tools have the potential to improve health outcomes and 29 quality of life for underserved youth who often may not benefit from advances in HIV care 30 through addressing factors uniquely relevant to them.

1名患有艾滋病毒（YPLWH）的年轻人患艾滋病毒自我管理不良的风险很高， 2可检测到88％的可检测病毒负荷，对于危害饮酒，可能对艾滋病毒产生负面影响 3治疗和预防级联。改善两种酒精的自我管理的干预措施 4使用和艾滋病毒护理至关重要，但成功的部分原因是未能说明 5对于该人群独有的发展和文化特征以及压力和创伤 6由这些特征赋予。 YPLWH是种族，种族和性不成比例的 7个少数族裔经历了更高的慢性和复杂压力来源的比率 8一生。此外，还有与压力和创伤的压迫根源 9他们的种族，种族，性和性别认同和艾滋病毒状况，例如歧视， 由于系统性结构和社会不平等，10个微侵略和污名。虽然 11压力与酒精使用和疾病管理有关，这些途径是这些的途径 YPLWH之间的12个链接知之甚少。有证据表明几个可修改的因素 13可以在这些间接途径中发挥作用。压力与睡眠不良有关， 14可能会影响酒精使用和艾滋病毒的自我管理，从而影响睡眠不佳 15关于情绪调节。行为调节（例如，决策，抑制控制）是核心 16自我管理的组成部分，并可能同样介导累积之间的关联 17压力和饮酒。与P01的总体目标一致，以提高自我管理 在YPLWH中，18个酒精使用和艾滋病毒护理，该项目将在发展上定义，并且 19与累积应力之间的因果途径中的文化相关，可修改的干预目标 20和YPLWH中的自我管理成果，其中大多数都受到交叉的影响 21种压力和创伤来源。使用创新的外展方法，我们将注册300种不同 22 YPLWH年龄18-29岁，以完成累积和界面压力和创伤的调查，睡眠 23健康（即使用电子睡眠日记的调查和生态瞬时分析[EMA]， 24基线时的情绪和行为调节，以及9和18的物质使用和HIV结果 25个月。此外，少数民族YPLWH较小的筛选可能性或可​​以访问可用的可能性 26个干预措施。在第五年，我们将使用一种混合方法与 27个社区成员开发一个适应性可扩展措施的工具包 28定位。由此产生的知识和工具有可能改善健康成果和 29服务不足的年轻人的生活质量，他们通常不会从艾滋病毒护理的进步中受益 30通过解决与他们唯一相关的因素。