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 感染艾滋病毒的年轻人 (YPLWH) 面临艾滋病毒自我管理不力的高风险， 2 可检测到的病毒载量为 88%，并且危险饮酒会对 HIV 产生负面影响 3 治疗和预防级联。改善酒精自我管理的干预措施 4 使用和艾滋病毒护理至关重要，但取得的成功有限，部分原因是未能考虑到 5 该人群独特的发展和文化特征以及压力和创伤 6 赋予这些特性。 YPLWH 的种族、民族和性别比例不成比例 7 个少数群体遭受慢性和复杂的压力和创伤的几率较高 8.一生。此外，还有与以下方面有关的压力和创伤的压抑来源： 9 他们的种族、民族、性取向和性别认同以及艾滋病毒状况，例如歧视、 10 由于系统性结构和社会不平等而产生的微侵犯和耻辱。虽然 11 压力与饮酒和疾病管理有关，其背后的途径 YPLWH 之间的 12 个联系知之甚少。有证据表明有几个可改变的因素 13 可能在这些间接途径中发挥作用。压力与睡眠健康状况不佳有关， 14 这可能会通过睡眠不佳影响饮酒和艾滋病毒自我管理 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，同样可以调解累积的关联 17 压力和饮酒。与P01提升自我管理的总体目标一致 18 YPLWH 中的酒精使用和艾滋病毒护理，该项目将从发展和 累积压力之间因果路径中的 19 个与文化相关、可修改的干预目标 20 以及 YPLWH 中的自我管理结果，其中大多数人受到交叉影响 21 种压力和创伤的来源。通过创新的推广方法，我们将招募 300 名不同的 22 名 18-29 岁的 YPLWH 完成累积和并发压力和创伤、睡眠调查 23 健康（即使用电子睡眠日记进行调查和生态瞬时分析 [EMA]）， 24 基线时的情绪和行为调节、物质使用和艾滋病毒结果，9 和 18 25个月。此外，少数 YPLWH 不太可能接受筛查或获得可用的 26 次干预。在第五年，我们将与以下机构合作使用混合方法 27 名社区成员将开发一套适应可扩展干预措施的工具包 28 瞄准。由此产生的知识和工具有可能改善健康结果和 29 服务不足的青少年的生活质量通常可能无法从艾滋病毒护理的进步中受益 30 通过解决与他们独特相关的因素。