Identifying Modifiable Risk and Protective Processes at the Day-Level that Predict HIV Care Outcomes Among Women Exposed to Partner Violence

识别日间可改变的风险和保护流程，预测遭受伴侣暴力的妇女的艾滋病毒护理结果

• 批准号: 10308056
• 负责人: Jaimie Meyer
• 金额: $ 60.86万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308056
• 关键词: Address; Adherence; Adult; Affect; Anti-Retroviral Agents; Anxiety; Attention; Awareness; Caring; Characteristics; Chronic; Chronic Disease; Clinic; Cluster randomized trial; Collaborations; Communities; Connecticut; Continuity of Patient Care; Cross-Sectional Studies; Data; Data Collection; Detection; Development; Disease; Enrollment; Exposure to; Face; Follow-Up Studies; Frequencies; Funding; Future; HIV; HIV risk; Health; Individual; Intervention; Interview; Mediating; Mental Depression; Mental Health; Meta-Analysis; Methods; Outcome; Patients; Pattern; Pharmaceutical Preparations; Process; Protocols documentation; Provider; Psychiatric therapeutic procedure; Public Health; Randomized; Research; Resources; Risk; Risk Reduction; Self Efficacy; Self Management; Social support; Specialist; Subgroup; Substance Use Disorder; Target Populations; Testing; Time; Training; Treatment outcome; Violence; Viral; Woman; base; care outcomes; community organizations; community violence; comorbidity; emotion regulation; experience; high risk population; improved; inattention; intimate partner violence; longitudinal design; mHealth; medication compliance; member; modifiable risk; negative affect; outreach; partner violence; protective effect; protective factors; psychologic; recruit; resilience; scale up; screening and brief intervention; screening, brief intervention, referral, and treatment; standard of care; substance use; tool; trauma symptom; treatment as usual; violence exposure; violence victimization

Project Summary Problem: Over half of women living with HIV (WLWH) have been exposed to intimate partner violence (IPV), a rate 12 to 32 times higher than women nationally. IPV-exposed (vs. non-exposed) women have significantly poorer engagement in HIV care and lower likelihood of viral suppression. Though integrated IPV-HIV interventions exist, they focus on HIV risk reduction, which is less relevant to managing HIV day-to-day. Attention to daily details is critical in this high-risk population - IPV-exposed WLWH face unique challenges managing daily aspects of HIV. Purpose: The main purpose of this study is to understand how exposure to IPV affects women's abilities to self-manage their HIV on a daily basis and to engage in longitudinal HIV care. The study will also evaluate the effect of an IPV-health focused screening, brief intervention and referral to care (SBIRT) protocol compared to standard of care on women's HIV care engagement. Methods: 315 adult women living with HIV and ever exposed to IPV will be enrolled. Women who are “in-care” will be recruited through Ryan White-funded HIV clinics. Women who are “out-of-care” will be recruited through Connecticut Department of Public Health Disease Intervention Specialist outreach workers. After enrollment and a baseline interview, women will complete 28 days of daily data collection on antiretroviral (ARV) adherence and potential risk (substance use, depression/trauma symptoms, and IPV) and protective (emotion regulation, self- efficacy) factors. At the month 3 follow-up study interview, women will be randomized to receive either an IPV-health focused SBIRT or standard of care. Women will complete an exit study interview at month 6. Aims (1) To identify proximal determinants of daily ARV adherence and determine if protective factors mediate and violence characteristics moderate associations; (2) To characterize latent subgroups of WLWH based on proximal determinants of daily ARV adherence and determine their relationship to retention in care and viral suppression. (3) To test the effects of an IPV-health intervention, compared to standard of care on ARV adherence, retention in care and viral suppression. Significance: Findings will inform the development of future individual-level interventions in collaboration with community partners and their patients and a cluster randomized trial of HIV clinics to assess the broader efficacy of a clinic-level intervention. IPV-exposed WLWH are a key target population for scaling up the HIV care continuum. Successful treatment outcomes hinge on optimal daily self-management. This project draws on the strengths of the study team to address the IPV- health connection and improve the lives of women.

项目概要 问题：超过一半的艾滋病毒感染者 (WLWH) 遭受过亲密伴侣暴力 (IPV)， 全国范围内，接触 IPV 的女性（与未接触 IPV 的女性相比）的比率显着高出 12 至 32 倍。 虽然综合了 IPV-HIV，但艾滋病毒护理参与度较差，病毒抑制的可能性较低。 尽管存在干预措施，但它们的重点是降低艾滋病毒风险，这与日常管理艾滋病毒的相关性较小。 对于这一高危人群，关注日常细节至关重要 - 暴露于 IPV 的 WLWH 面临着独特的挑战 管理艾滋病毒的日常方面 目的：本研究的主要目的是了解如何接触艾滋病毒。 IPV 影响女性日常自我管理艾滋病毒和参与艾滋病毒护理的能力。 该研究还将评估以 IPV 健康为重点的筛查、简短干预和转诊护理的效果 (SBIRT) 方案与女性艾滋病毒护理参与度护理标准的比较方法：315 名成年人。 感染艾滋病毒并曾经接触过 IPV 的女性将被招募。 通过瑞安·怀特（Ryan White）资助的艾滋病毒诊所，将通过康涅狄格州招募“失去护理”的妇女。 公共卫生部疾病干预专家外展人员入职后。 基线访谈中，女性将完成 28 天的每日抗逆转录病毒 (ARV) 依从性数据收集， 潜在风险（药物使用、抑郁/创伤症状和 IPV）和保护性（情绪调节、自我保护） 在第 3 个月的随访研究访谈中，女性将被随机分配接受 以 IPV 健康为重点的 SBIRT 或护理标准。女性将在第 6 个月完成退出研究访谈。 目标 (1) 确定每日 ARV 依从性的近端决定因素，并确定保护性因素是否介导和 暴力特征调节关联；（2）根据 每日 ARV 依从性的近端决定因素，并确定它们与护理保留和病毒的关系 (3) 与 ARV 护理标准相比，测试 IPV 健康干预措施的效果。 坚持、保留护理和病毒抑制 意义：研究结果将为疾病的发展提供信息。 未来与社区合作伙伴及其患者和集群合作进行个人层面的干预 HIV 诊所的随机试验，旨在评估临床层面暴露于 IPV 的 WLWH 干预措施的更广泛功效。 是扩大艾滋病毒护理连续性的关键目标人群，成功的治疗结果取决于。 该项目利用研究团队的优势来解决 IPV-问题。 健康联系并改善妇女的生活。