Building mobile HIV prevention and mental health support in low-resource settings

在资源匮乏的地区建立流动艾滋病毒预防和心理健康支持

• 批准号: 10332885
• 负责人: Corina Lelutiu-Weinberger
• 金额: $ 10万
• 依托单位: RBHS-SCHOOL OF NURSING
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10332885
• 关键词: AIDS prevention; Address; Alcohol abuse; Alcohols; Behavioral; Bisexual; Caring; Cellular Phone; Cognitive; Collaborations; Communicable Diseases; Communities; Complex; Counseling; Country; Data; Development; Eastern Europe; Ensure; Epidemic; European; Face; Funding; Future; Gays; Gender; Geography; HIV; HIV risk; Health; Health Personnel; Healthcare; Healthcare Systems; Homelessness; Human immunodeficiency virus test; Imprisonment; Individual; Infrastructure; Intervention; Intervention Studies; Interview; Knowledge; Lesbian Gay Bisexual Transgender Queer; Manuals; Mental Depression; Mental Health; Minority; Motivation; National Institute of Mental Health; Needs Assessment; Nongovernmental Organizations; Outcome; Participant; Patients; Personal Satisfaction; Persons; Population; Privacy; Process; Protocols documentation; Psyche structure; Randomized Controlled Trials; Reporting; Research; Research Support; Resources; Rights; Risk; Romania; Secure; Self Efficacy; Self-Injurious Behavior; Sexual Health; Stigmatization; Stress; Stress and Coping; Structure; Substance abuse problem; Tablets; Techniques; Testing; Text; Translating; Treatment Efficacy; Unemployment; United States National Institutes of Health; Violence; Work; acceptability and feasibility; anxiety symptoms; arm; base; behavioral health; comorbidity; condoms; depressive symptoms; efficacy testing; evidence base; experience; follow-up; gender minority; handheld mobile device; health care availability; improved; laptop; mHealth; men; motivational enhancement therapy; programs; response; sex; skills; skills training; social stigma; stressor; theories; transgender

Project Summary Transgender and gender diverse (e.g., gender non-binary) (TGD) individuals remain a hidden group in the Central Eastern European (CEE) country of Romania, with few protections, few equal rights, and many unmet needs. Emerging research with TGD persons in the region indicates that TGD Romanians report particularly high rates of HIV, depression, and hazardous alcohol use, primarily driven by the country’s high structural stigma. Romania’s healthcare system has little expertise for addressing these syndemic health threats. No targeted needs assessments or interventions exist to date in order to remedy these adversities and promote the wellbeing of TGD in Romania, or anywhere in CEE – the region with the fastest-growing HIV epidemic in the world. In response, we propose to create and pilot-test the first intervention in CEE to address the sexual, mental, and behavioral health of TGD people. In 2014, with input from the Romanian LGBTQ community, we created the Comunică [Communicate] intervention, which successfully helped reduce gay and bisexual men’s HIV risk and hazardous alcohol use and improve their mental health. The intervention’s theory and techniques are based on motivational interviewing and cognitive behavioral skills training as adapted for minority stress. Live counseling sessions are delivered by text on a secure platform accessed on any mobile device, which is responsive to participants’ high need for mobility and concealment. In this supplement, we propose to now adapt and pilot-test Comunică to address the shared and unique minority stress determinants facing TGD Romanians to reduce HIV risk, depression, and hazardous alcohol use. Our adaptation will be guided by the gender minority stress framework that acknowledges unique TGD stressors, whose impact our intervention intends to modify. In Aim 1 (mos 1-5), we will identify the unique health needs of Romanian TGD individuals and modify the Comunică intervention to address them. We will interview 20 Romanian TGD individuals who report HIV risk, depression, and hazardous alcohol use, and 10 TGD-affirmative health providers to identify TGD-specific health needs and suggested adaptations to Comunică. In Aim 2 (mo 6), we will iteratively modify the Comunică intervention content to address gender minority stress and other TGD-specific determinants of HIV risk, mental health, and hazardous alcohol use. Finally, in Aim 3 (mos 7-12), we will evaluate the new intervention’s feasibility and acceptability in a one-arm trial with 20 TGD Romanians who report HIV risk, depression, and hazardous alcohol use. Data will be collected at baseline and 3-month follow-up. This project builds on our strong NIH-supported research program focused on the health of LGBTQ people in Romania, in order to create the first intervention to address the sexual, mental, and behavioral health of TGD Romanians. By extending our intervention research to at-risk TGD populations, we will ensure more equitable access to our interventions and embed them within a national infrastructure increasingly eager for and capable of reaching the full diversity of the Romanian LGBTQ population to address its currently unmet needs.

项目摘要 跨性别和性别多样化（例如，性别非二元）（TGD）个人仍然是一个隐藏的群体 罗马尼亚中部东欧国家（CEE）国家，几乎没有保护，几乎没有平等权利，许多未得到满足 需要。与该地区的TGD人员的新兴研究表明，TGD罗马尼亚人特别报告 艾滋病毒，抑郁症和危害饮酒的高率主要是由该国高结构的驱动 柱头。罗马尼亚的医疗保健系统几乎没有专业知识来应对这些综合健康威胁。不 有针对性的需求评估或干预措施迄今为止，以记住这些逆境并促进 TGD在罗马尼亚的福祉或中央区的任何地方 - 该地区的艾滋病毒流行最快 世界。作为回应，我们建议创建和试点测试中央E的首次干预，以解决性行为， TGD人士的心理和行为健康。 2014年，随着罗马尼亚LGBTQ社区的投入，我们 创建了通讯[交流]干预，成功地减少了同性恋和双性恋男性 艾滋病毒的风险和危险的饮酒并改善其心理健康。干预的理论和技术 基于动机访谈和认知行为技能培训，以适应少数派压力。 实时咨询会议是通过文本在任何移动设备上访问的安全平台上提供的，即 对参与者对流动性和隐藏的高需求做出反应。在这种补充中，我们建议现在 适应和试点测试通信解决共同且独特的少数派压力决定了面部TGD 罗马尼亚人减少艾滋病毒风险，抑郁和危害饮酒。我们的改编将由 性别少数压力框架承认独特的TGD压力源，他们的干预影响 打算修改。在AIM 1（MOS 1-5）中，我们将确定罗马尼亚TGD个人的独特健康需求 并修改通信干预以解决它们。我们将采访20个罗马尼亚TGD个人 报告艾滋病毒的风险，抑郁和危险饮酒，以及10个TGD可靠的健康提供者 TGD特定的健康需求，并建议适应通信。在AIM 2（mo 6）中，我们将迭代修改 通信干预内容以解决性别少数压力和其他TGD特定的决定 艾滋病毒风险，心理健康和危害饮酒。最后，在AIM 3（MOS 7-12）中，我们将评估新的 干预的可行性和可接受性在一臂之一 抑郁症和危害酒精的使用。数据将在基线和3个月的随访中收集。这个项目 建立在我们强大的NIH支持研究计划的基础上，重点是罗马尼亚LGBTQ人的健康 为了创建第一个干预措施以解决TGD罗马尼亚人的性，心理和行为健康。 通过将干预研究扩展到高危TGD人群，我们将确保更公平地访问我们的 干预措施并将其嵌入到国家基础设施中，越来越渴望并能够达到 罗马尼亚LGBTQ人口的全部多样性以满足其目前未满足的需求。