Woman-Focused HIV Prevention with Pregnant African-Americans in Treatment

以女性为中心的艾滋病毒预防与怀孕的非洲裔美国人的治疗

• 批准号: 7038134
• 负责人: WENDEE M WECHSBERG
• 金额: $ 40.92万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7038134
• 关键词: AIDS education /prevention; AIDS therapy; African American; HIV infections; behavior therapy; behavioral /social science research tag; child rearing; clinical research; clinical trials; comorbidity; crack cocaine; culture; drug abuse therapy; female; focus groups; high risk behavior /lifestyle; human subject; human therapy evaluation; interpersonal relations; patient oriented research; pregnancy; prenatal care; publications; sex behavior; social support network; therapy design /development; urinalysis

DESCRIPTION (provided by applicant): Substance abuse among pregnant women can have significant public health consequences for their children. Further, HIV surveillance indicates that African-American women in North Carolina of low socioeconomic status are at high risk for HIV and other sexually transmitted infections (STIs) (MMWR, 2005). These women may engage in high-risk sexual behaviors that are often linked to drug use, and they face significant health disparities based on poverty, unemployment, lack of resources, and a lack of access to substance abuse treatment. These health issues may subsequently affect their offspring. Research in Raleigh-Durham, North Carolina (NC), indicates that many of these women are crack cocaine abusers with comorbid conditions, including historical and current victimization from intimate partners. In a staged proposal, we propose to iteratively adapt and modify the NC woman-focused intervention (Women's CoOp), including the field manual and instrumentation, to focus on pregnant African-American women who abuse crack, are currently in substance abuse treatment, and are at risk for HIV or are HIV positive. We then propose to test the newly developed intervention in a Stage IB pilot-sized randomized clinical trial (RCT) in a traditional substance abuse treatment clinic to determine (a) feasibility; (b) relative efficacy compared with substance abuse treatment-as-usual (TAU), across several domains of functioning (e.g., substance use, HIV risk behaviors); and (c) the intervention's potential mechanisms of action. The specific aims of this Stage IA/B study are as follows: Aim 1. To adapt the culturally specific, manualized woman-focused intervention to specifically address issues of pregnancy and substance abuse, relationships with men, social support, parenting, HIV status, living with HIV, antiretroviral (ARV) treatment, and HIV risk-reduction methods for pregnant and postpartum women. Aim 2. To compare the relative efficacy of the woman-focused intervention for pregnant women relative to standard substance abuse treatment to sustain reductions in substance abuse and sexual risk behaviors, maintain retention in drug treatment, reduce violence, and improve prenatal care and ARV treatment adherence (as needed) at 3- and 6-month follow-up. Aim 3. To explore the intervention's potential mechanisms of action (e.g., by examining the mediating effects of changes in knowledge about HIV risk behaviors, psychological distress, readiness for change) and moderating factors (e.g., HIV status, age, stage of pregnancy, relationships with men) that may influence response to the treatment.

描述（由申请人提供）： 孕妇滥用药物可能会对她们的孩子产生严重的公共卫生后果。此外，艾滋病毒监测表明，北卡罗来纳州社会经济地位较低的非洲裔美国妇女感染艾滋病毒和其他性传播感染（STI）的风险很高（MMWR，2005）。这些妇女可能会从事通常与吸毒有关的高风险性行为，并且由于贫困、失业、缺乏资源和无法获得药物滥用治疗，她们面临着巨大的健康差异。这些健康问题可能随后影响他们的后代。北卡罗来纳州罗利达勒姆 (Raleigh-Durham) 的研究表明，其中许多女性都是可卡因滥用者，患有合并症，包括过去和现在受到亲密伴侣的伤害。在分阶段提案中，我们建议迭代调整和修改以北卡罗来纳州妇女为中心的干预措施（妇女合作社），包括现场手册和仪器，以重点关注滥用可卡因、目前正在接受药物滥用治疗的非裔美国孕妇，以及有感染艾滋病毒的风险或艾滋病毒呈阳性。然后，我们建议在传统药物滥用治疗诊所的 IB 期试点随机临床试验 (RCT) 中测试新开发的干预措施，以确定 (a) 可行性； (b) 与常规药物滥用治疗（TAU）相比，在多个功能领域（例如药物使用、艾滋病毒危险行为）的相对疗效； (c) 干预措施的潜在作用机制。 本阶段IA/B研究的具体目标如下： 目标 1. 调整针对特定文化、以女性为中心的手动干预措施，专门解决怀孕和药物滥用、与男性的关系、社会支持、养育子女、艾滋病毒状况、艾滋病毒感染者、抗逆转录病毒 (ARV) 治疗和艾滋病毒风险等问题。孕妇及产后妇女的减量方法。 目标 2. 比较针对孕妇的以妇女为中心的干预措施与标准药物滥用治疗的相对功效，以持续减少药物滥用和性危险行为、维持药物治疗、减少暴力以及改善产前护理和抗逆转录病毒治疗3 个月和 6 个月随访时的依从性（根据需要）。 目标 3. 探索干预措施的潜在作用机制（例如，通过检查有关艾滋病毒危险行为、心理困扰、改变准备程度的知识变化的中介效应）和调节因素（例如，艾滋病毒状况、年龄、怀孕阶段、与男性的关系）可能会影响对治疗的反应。