Improving the health of South African women with traumatic stress in HIV care

改善在艾滋病毒护理中遭受创伤性压力的南非妇女的健康

基本信息

批准号：
8729135
负责人：
KATHLEEN J SIKKEMA
金额：
$ 20.34万
依托单位：
DUKE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-11 至 2017-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8729135
关键词：
Acquired Immunodeficiency Syndrome Address Adherence Adult African Aftercare Alcohol or Other Drugs use Behavior Behavioral Caring Centers for Disease Control and Prevention (U.S.)Child Sexual Abuse Clinic Clinical Consequences of HIV Continuity of Patient Care Coping Behavior Counseling Data Data Collection Data Set Development Distress Drops Educational Curriculum Epidemic Evaluation Evidence based treatment Face Feedback Female Goals HIV HIV risk Health Health Services Health behavior Individual Intervention Intervention Studies Life Medical Records Mental Health National Institute of Mental Health Nurse Psychotherapist Outcome Participant Patients Personal Satisfaction Population Primary Health Care Probability Protocols documentation Provider Psychiatric Nursing Randomized Randomized Controlled Trials Recording of previous events Reporting Research Risk Risk Behaviors South Africa Stress Stress and Coping Structure Testing Trauma United States Virus Vulnerable Populations Woman Work antiretroviral therapy base brief intervention care systems clinical care coping critical period effective intervention experience high risk improved men patient population prevent psychologic public health relevance response sex risk sexual assault sexual trauma sexual violence standard of care success theories therapy development transmission process

项目摘要

DESCRIPTION (provided by applicant): HIV-infected women in South Africa report high rates of sexual trauma, which negatively impacts their mental health and potentially influences engagement in HIV care (retention in care and adherence to antiretroviral therapy) and risk behaviors. Addressing the traumatic stress resulting from sexual trauma could improve these HIV-related outcomes, which in turn may prevent HIV transmission through suppression of the virus and reduction in HIV risk behaviors. Intervention research among HIV-infected populations with trauma histories in the U.S. demonstrates that a coping approach, particularly one that reduces the use of avoidant coping strategies, is efficacious in reducing traumatic stress and improving health behaviors. Although South Africa faces dual epidemics of HIV and sexual violence, trauma treatment has not been well-integrated into the HIV care setting. The proposed 3-year study will develop and pilot test an intervention called ImpACT (Improving AIDS Care after Trauma) to reduce avoidant coping, traumatic stress, and risk behaviors, and increase engagement in care. The intervention will take place in a public ART clinic and will target women during the critical period when they initiate ART in order to maximize the impact on engagement in care. Qualitative data collection with staff, providers, and HIV-infected female patients at the study clinic will elicit feedback on the content and delivery of ImpACT and key aspects of the study protocol. ImpACT will then be piloted with 60 women who are new ART enrollees with a history of sexual trauma and elevated traumatic stress. Participants will be randomized to the control condition (standard of care, or SoC: 3 adherence counseling sessions required of all patients initiating ART at the clinic) or the intervention condition (SoC + ImpACT) and will complete assessments at baseline, 3, and 6 months post-randomization, with care engagement data extracted from medical records at the end of the study period. The study has three specific aims: 1) to develop a brief and scalable coping intervention for delivery in the South African HIV care setting for women with sexual trauma histories; 2) to establish the methodological details of an experimental protocol for a robust randomized control trial; and 3) to pilot test the ImpACT intervention with 60 HIV-infected women with histories of sexual trauma who are initiating ART in order to determine feasibility and acceptability in the HIV care setting, and explore the impact on avoidant coping, traumatic stress, engagement in care, and HIV risk behaviors. The goal at the completion of this study is to have a structured intervention curriculum that is culturally relevant for HIV infected women in South Africa, a full experimental protocol that is appropriate for the South African care setting, and data on feasibility, acceptability, and target outcomes. These products can be leveraged to inform an R01 application for rigorous evaluation of the ImpACT intervention. We are confident that this developmental work will significantly enhance the probability of success of a larger randomized control trial.

描述（由申请人提供）：南非的HIV感染妇女报告了高度的性创伤率，这会对其心理健康产生负面影响，并可能影响参与HIV护理（保留和遵守抗逆转录病毒疗法）和风险行为和风险行为。解决因性创伤引起的创伤应力可以改善这些与HIV相关的结果，这反过来又可以通过抑制病毒和减少HIV风险行为来阻止HIV传播。在美国具有创伤历史的HIV感染人群中的干预研究表明，一种应对方法，尤其是减少回避应对策略的一种应对方法，可以有效地减少创伤性压力和改善健康行为。尽管南非面临着艾滋病毒和性暴力双重流行病，但创伤治疗尚未得到充分融合到艾滋病毒护理环境中。拟议的三年研究将开发和试点测试一种称为影响（改善创伤后的艾滋病护理），以减少回避应对，创伤压力和风险行为，并增加护理的参与度。干预措施将在公共艺术诊所进行，并在关键时期启动艺术品以最大程度地影响对护理参与的影响时，将针对妇女。研究诊所向员工，提供者和感染HIV的女性患者收集定性数据将引起研究方案的影响和交付以及关键方面的反馈。然后，将为60名女性带来撞击，这些女性是具有性创伤史和较高创伤性压力史的新艺术招待所。参与者将被随机分配到控制状态（护理标准或SOC：3依从性咨询会议，要求所有患者在诊所启动ART的患者或干预条件（SOC +影响），并将在运送后的3个月和6个月后完成评估，并在研究期结束时从医疗记录中提取护理数据。这项研究具有三个具体的目的：1）为有性创伤病史的妇女开发短暂，可扩展的应对干预措施，以在南非艾滋病毒护理环境中提供分娩； 2）建立一个实验方案的方法论细节，以进行强大的随机对照试验； 3）试点测试60名艾滋病毒感染的妇女的影响干预措施，这些妇女的性创伤历史是为了确定艾滋病毒护理环境中的可行性和可接受性，并探讨对回避应对，创伤压力，参与护理和艾滋病毒风险行为的影响。这项研究完成的目的是拥有与南非的艾滋病毒感染妇女有关的结构化干预课程，该课程适用于南非的艾滋病毒感染妇女，这是一种适合南非护理环境的完整实验方案，以及有关可行性，可接受性和目标结果的数据。可以利用这些产品来告知R01申请，以严格评估影响干预措施。我们相信，这项发展工作将显着提高更大的随机对照试验成功的可能性。