Preventing HIV among Native Americans through the treatment PTSD & substance use

通过治疗创伤后应激障碍 (PTSD) 预防美洲原住民艾滋病毒

• 批准号: 9127517
• 负责人: DEBRA L KAYSEN
• 金额: $ 70.07万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-27 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9127517
• 关键词: AIDS prevention; Address; Alaska Native; Alcohol dependence; Alcohol or Other Drugs use; American; American Indians; Area; Assertiveness; Behavior; Client; Clinical; Collaborations; Communication; Communities; Coupled; Development; Diagnosis; Drug Addiction; Elderly; Elements; Evidence based intervention; Evidence based program; Evidence based treatment; Face; Frequencies; Future Generations; Goals; HIV; HIV risk; HIV/STD; Health Promotion; Individual; International; Intervention; Left; Life; Mediating; Mediator of activation protein; Mental Health; Meta-Analysis; Methods; Motivation; Native Americans; Oral; Outcome; Pathway interactions; Population; Population Heterogeneity; Post-Traumatic Stress Disorders; Prevention; Public Health; Randomized; Relapse; Reservations; Resources; Risk; Risk Behaviors; Risk Factors; Self Efficacy; Self Medication; Severities; Sexual Partners; Substance Addiction; Substance Use Disorder; Substance abuse problem; Symptoms; Tactile; Testing; Time; Trauma; Tribes; Unsafe Sex; Washington; Woman; arm; base; behavioral outcome; cognitive reappraisal; comparative effectiveness; condoms; coping; disorder prevention; effectiveness trial; emotion regulation; follow-up; health disparity; high risk; improved; men; motivational enhancement therapy; pilot trial; post intervention; prevent; programs; public health relevance; reduced substance use; sex; sex risk; skills; skills training; substance misuse; substance use prevention; trial comparing; tribal Nation; AIDS prevention; Address; Alaska Native; Alcohol dependence; Alcohol or Other Drugs use; American; American Indians; Area; Assertiveness; Behavior; Client; Clinical; Collaborations; Communication; Communities; Coupled; Development; Diagnosis; Drug Addiction; Elderly; Elements; Evidence based intervention; Evidence based program; Evidence based treatment; Face; Frequencies; Future Generations; Goals; HIV; HIV risk; HIV/STD; Health Promotion; Individual; International; Intervention; Left; Life; Mediating; Mediator of activation protein; Mental Health; Meta-Analysis; Methods; Motivation; Native Americans; Oral; Outcome; Pathway interactions; Population; Population Heterogeneity; Post-Traumatic Stress Disorders; Prevention; Public Health; Randomized; Relapse; Reservations; Resources; Risk; Risk Behaviors; Risk Factors; Self Efficacy; Self Medication; Severities; Sexual Partners; Substance Addiction; Substance Use Disorder; Substance abuse problem; Symptoms; Tactile; Testing; Time; Trauma; Tribes; Unsafe Sex; Washington; Woman; arm; base; behavioral outcome; cognitive reappraisal; comparative effectiveness; condoms; coping; disorder prevention; effectiveness trial; emotion regulation; follow-up; health disparity; high risk; improved; men; motivational enhancement therapy; pilot trial; post intervention; prevent; programs; public health relevance; reduced substance use; sex; sex risk; skills; skills training; substance misuse; substance use prevention; trial comparing; tribal Nation

 DESCRIPTION (provided by applicant): Untreated PTSD elevates risk of concurrent alcohol and drug dependence (>50% and >30% respectively), which in turn elevates risk of HIV sexual-risk behavior (HSB). A meta-analysis of HIV prevention, found few interventions address risk factors such as trauma exposure, mental health, or SUD and interventions which failed to do so had poorer condom use outcomes and were less effective for those with PTSD. From a public health perspective addressing PTSD and substance use disorders (SUD) is an important but overlooked means of preventing HIV/STI. American Indian (AI) communities are at disproportionate risk for untreated PTSD, SUD and HIV/STI risk. Self-medication of PTSD through substance use leads to development of SUDs, and exacerbates HSB. Therefore, treatment of PTSD that also decreases substance use in individuals may prevent the initiation or relapse of HIV risk behaviors. Similarly, directly intervening to reduce substance use via increasing motivation to decrease use and enhance coping strategies should prevent SUD development, and improve HSB and PTSD. Thus addressing PTSD or substance use may effectively prevent HSB. Built on an 8-year community-based participatory partnership, in full collaboration with the Tribal Nation, this study proposes a 5-year two-arm randomized comparative effectiveness trial to evaluate prevention of HIV/STI sexual risk behavior by directly addressing PTSD or substance use. We will evaluate Narrative Exposure Therapy (NET) versus Motivational Interviewing with Skills Training (MIST) in HIV/STI prevention. AI elder and community leaders have insisted that "we can keep providing substance use or sexual risk programs but until we get to the underlying cause - trauma - then we'll keep replacing one means of avoidance for another". This study will help address this community-generated clinical and empirical question. The overall goal is to compare two evidence based treatments, each addressing a different HSB causal pathway. NET addresses PTSD preventing SUD and HSB. MIST addresses substance misuse preventing SUD and HSB. Aim 1: To examine a PTSD versus a substance use-focused intervention to prevent HSB. We will conduct a two-arm randomized comparative effectiveness trial comparing NET (n=100) to MIST (n=100) among AI men and women with PTSD symptoms. We will evaluate the effect of reductions in PTSD severity and substance use (e.g., frequency, quantity, intentions, relapse, and initiation of use) on HSB (e.g., number of partners, sex while using substances, unprotected sex, and sex with high-risk partners) at post, 6, and 12-month follow-up. Aim 2: To examine theoretical mediators of treatment on HSB outcomes including emotional regulation, cognitive reappraisals, coping self-efficacy, communication skills, assertiveness, and community connectiveness.

 描述（由适用提供）：未经处理的PTSD提高了同时酒精和药物依赖的风险（分别> 50％和> 30％），进而提高了HIV性风险行为（HSB）的风险。对艾滋病毒预防的荟萃分析发现，几乎没有干预措施解决了诸如创伤，心理健康或SUD和干预措施之类的风险因素，但避孕套的使用结果较差，对PTSD患者的效果较差。从公共卫生的角度来看，针对PTSD和药物使用障碍（SUD）是预防HIV/STI的一种重要手段。美洲印第安人（AI）社区对未经治疗的PTSD，SUD和HIV/STI风险的风险不成比例。通过使用物质对PTSD进行自我治疗会导致SUD的发展，并加剧HSB。因此，对个体中底物使用的PTSD的治疗可能会阻止艾滋病毒风险行为的启动或缓解。同样，通过增加动力减少使用和增强涂料策略的动力直接干预以减少物质的使用，应防止SUD开发，并改善HSB和PTSD。该解决PTSD或物质使用可以有效防止HSB。这项研究建立在与部落国家完全合作的基于8年的社区参与伙伴关系的基础上，提出了一项为期5年的两臂随机比较有效性试验，以通过直接解决PTSD或药物使用来评估预防HIV/STI性风险行为。我们将评估叙事暴露疗法（网络）与艾滋病毒/STI预防中技能培训（MIST）的动机访谈。 AI老年人和社区领导人已经传达了“我们可以继续提供药物使用或性风险计划，但是直到我们达到根本原因 - 创伤之前 - 然后，我们将继续替换一种避免另一种避免手段的方法”。这项研究将有助于解决这个社区生成的临床和经验问题。总体目标是比较两种基于证据的治疗方法，每种治疗方法都解决了不同的HSB因果途径。 NET地址是防止SUD和HSB的PTSD。薄雾解决了滥用药物，阻止了SUD和HSB。目标1：检查PTSD与以物质使用为中心的干预措施以防止HSB。我们将在患有PTSD症状的AI男性和女性中进行两臂随机比较有效性试验，将净（n = 100）与雾（n = 100）进行比较（n = 100）。我们将评估PTSD严重程度和物质使用的减少（例如频率，数量，意图，继电器和使用的使用）对HSB的影响（例如，伴侣的数量，性别，性别，不受保护的性别，与高风险的性别，以及与高风险的伴侣的性别，6个，以及12个小时的随访）。目的2：检查理论介体对HSB结果的理论介体，包括情绪调节，认知重新评估，应对自我效能感，沟通技巧，自信和社区连接。