Improving HIV Care Engagement Among Ugandan Adolescent Girls and Young Women Through Reductions in Male Partner Alcohol Use and Intimate Partner Violence Risk: The Kisoboka Mukwano Intervention

通过减少男性伴侣饮酒和亲密伴侣暴力风险，提高乌干达少女和年轻女性的艾滋病毒护理参与度：Kisoboka Mukwano 干预措施

• 批准号: 10542322
• 负责人: Susan Maria Kiene
• 金额: $ 24.21万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542322
• 关键词: Address; Affect; Africa South of the Sahara; Alcohol consumption; Alcohols; Behavior; Behavioral; Caring; Clinical Trials; Collaborations; Conflict (Psychology); Control Groups; Counseling; Country; Couples; Development; Disease; Emotional; Ever Married; Female; Female Adolescents; Future; Gender; Glare; HIV; HIV Seronegativity; HIV diagnosis; Heavy Drinking; Heterosexuals; Intervention; Love; Marriage; Men' s Role; Mental Depression; Outcome; Pharmaceutical Preparations; Physical aggression; Population; Process; Qualitative Research; Randomized; Recording of previous events; Reporting; Research; Research Personnel; Risk; Safety; Spouses; Stress; Testing; Time; Treatment outcome; Uganda; Unsafe Sex; Viral; Viral Load result; Woman; aged; alcohol intervention; antiretroviral therapy; arm; base; binge drinking; coping; emotional abuse; experience; follow-up; health care availability; improved; improved outcome; informant; intervention effect; intimate partner violence; male; medication compliance; men; motivational enhancement therapy; peer; pill; pilot test; prevent; relationship abuse; sexual coercion; therapy adherence; transmission process; treatment as prevention; violence victimization; young woman

PROJECT SUMMARY / ABSTRACT In Uganda, adolescent girls and young women (AGYW) are disproportionately affected by HIV and have poor viral suppression rates, increasing their risk of onward transmission. Intimate partner violence (IPV) is a major barrier to mitigating the impact of HIV among AGYW. AGYW living with HIV (AGYWLHIV) in sub- Saharan Africa (SSA) who have experienced IPV have worse medication adherence, viral suppression, and care engagement than those without IPV. Further, male partner alcohol use directly and indirectly increases IPV risk among AGYW in SSA. Thus, an intervention with components that address heavy alcohol use among male partners could decrease AGYW’s IPV risk, especially in Uganda, which has the highest alcohol use per capita in SSA. Couples- based interventions have effectively reduced male partner alcohol use, relationship conflict IPV, and improved viral suppression and HIV care engagement; yet, none have been tailored to AGYWLHIV in SSA. We propose to develop and pilot a couples-based intervention that focuses on improving HIV care engagement and ART adherence among AGYWLHIV by reducing heavy alcohol use among male partners and couple IPV risk. Additionally, we will explore the intervention’s effects on AGYW viral load for the additional key benefit of treatment as prevention. Our aims are to: 1) Adapt the behavioral components of a brief MI-based alcohol intervention to create the proposed Kisoboka Mukwano (“It is possible, my love!”) intervention. The intervention will promote strategies for reductions in male partner alcohol use, coping with relationship conflict and stress, changing norms that reduce IPV and support engagement in HIV care and ART adherence among AGYWLHIV, and, thereby, enhance future sustained viral suppression and benefits of treatment as prevention. The intervention will be adapted and tailored to be delivered with heterosexual couples, involve peer navigators, address IPV, and be developmentally appropriate for AGYWLHIV in Uganda. We will develop and refine the intervention in collaboration with an intervention steering committee through: qualitative research with married/cohabiting AGYWLHIV, married/cohabiting men, and key informants and an initial pilot test with 6 couples. 2) We will assess safety, acceptability, feasibility, and preliminary estimates of the potential for the intervention, as compared to the control group, to improve HIV, alcohol, and IPV outcomes. We will examine preliminary effects on AGYW HIV care engagement, AGYW ART adherence, heavy alcohol use among male partners, and couple IPV risk and explore effects on AGYW viral load as well as intermediate outcomes related to intervention components. We will assess these outcomes at baseline and then at 3- and 6-month follow-up. Study findings will be used to guide a subsequent R01 proposal to test the intervention in a larger clinical trial.

项目概要/摘要 在乌干达，少女和年轻妇女 (AGYW) 受艾滋病毒影响尤为严重，并且 病毒抑制率低，增加了其继续传播亲密伴侣暴力（IPV）的风险。 减轻艾滋病毒对 AGYW 感染艾滋病毒 (AGYWLHIV) 的影响的主要障碍。 经历过 IPV 的撒哈拉非洲 (SSA) 患者的药物依从性、病毒抑制和病毒抑制能力较差 与没有 IPV 的护理参与度相比，男性伴侣饮酒直接和间接增加。 SSA 中 AGYW 的 IPV 风险因此需要采取干预措施来解决酗酒问题。 男性伴侣之间的性行为可能会降低 AGYW 的 IPV 风险，尤其是在酒精含量最高的乌干达 基于夫妇的干预措施有效减少了男性伴侣的饮酒量， 关系冲突 IPV，以及改善病毒抑制和艾滋病毒护理参与度； 我们建议开发和试点基于夫妇的干预措施，重点关注 SSA 中的 AGYWLHIV。 通过减少酗酒来提高 AGYWLHIV 人群的艾滋病毒护理参与度和抗逆转录病毒治疗依从性 此外，我们将探讨干预措施对 AGYW 的影响。 病毒载量作为预防的额外关键益处我们的目标是：1）调整行为。 基于 MI 的简短酒精干预措施的组成部分，旨在创建拟议的 Kisoboka Mukwano（“它是 有可能，我的爱人！”）干预措施将促进减少男性伴侣的策略。 饮酒、应对关系冲突和压力、改变减少 IPV 和支持的规范 AGYWLHIV 中艾滋病毒护理的参与和抗逆转录病毒疗法的依从性，从而增强未来的持续性 病毒抑制和治疗作为预防的益处将根据情况进行调整和调整。 与异性伴侣一起分娩，涉及同伴导航，解决 IPV 问题，并促进发展 我们将与乌干达的 AGYWLHIV 合作开发和完善干预措施。 干预指导委员会通过：对已婚/同居 AGYWLHIV 进行定性研究， 已婚/同居男性和关键知情人以及对 6 对夫妇进行初步试点测试 2) 我们将评估安全性， 与干预措施相比，干预措施的可接受性、可行性和初步估计 对照组，以改善 HIV、酒精和 IPV 结果，我们将检查 AGYW 的初步效果。 HIV 护理参与度、AGYW ART 依从性、男性伴侣酗酒以及夫妻 IPV 风险并探讨对 AGYW 病毒载量的影响以及与干预相关的中间结果 我们将在基线和 3 个月和 6 个月的随访研究中评估这些结果。 研究结果将用于指导后续的 R01 提案，以在更大规模的临床试验中测试干预措施。