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女性的艾滋病毒护理结果

• 批准号: 9912923
• 负责人: Jaimie Meyer
• 金额: $ 62.78万
• 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/9912923
• 关键词: Address; Adherence; Adult; Affect; Alcohol or Other Drugs use; 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; 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; 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.

项目摘要 问题：超过一半的艾滋病毒妇女（WLWH）暴露于亲密伴侣暴力（IPV）， 比全国妇女高12至32倍。 IPV暴露（与未暴露）女性具有显着 参与艾滋病毒护理和病毒抑制的可能性较低。虽然IPV-HIV集成 存在干预措施，他们专注于降低艾滋病毒风险，这与日常管理艾滋病毒的关系不大。 在这个高风险人群中，关注每日细节至关重要-IPV暴露的WLWH面临独特的挑战 管理艾滋病毒的每日方面。目的：这项研究的主要目的是了解如何接触 IPV会影响妇女每天自我管理艾滋病毒并从事纵向艾滋病毒护理的能力。 该研究还将评估以IPV健康为中心的筛查，简短干预并转介给CARE的效果 （SBIRT）协议与妇女艾滋病毒护理参与的护理标准相比。方法：315成人 患有艾滋病毒并曾接触过IPV的妇女将被招募。将招募“室内”的妇女 通过瑞安·怀特资助的艾滋病毒诊所。 “保管外”的妇女将通过康涅狄格州招募 公共卫生疾病干预系专家外展工作者。入学后和 基线访谈，妇女将完成28天的抗逆转录病毒（ARV）依从性和 潜在风险（吸毒，抑郁/创伤症状和IPV）和保护性（情绪调节，自我调节） 效率）因素。在第3个月的后续研究访谈中，妇女将被随机地接受 IPV-Health专注的SBIRT或护理标准。妇女将在第6个月完成一次退出研究访谈。 （1）确定每日ARV依从性的近端确定剂，并确定受保护因素是否介导和 暴力角色中等关联； （2）根据基于WLWH的潜在子组表征 每日ARV依从性的近端决定剂，并确定其与保留和病毒的保留关系 抑制。 （3）与ARV的护理标准相比，测试IPV健康干预的影响 依从性，保留护理和病毒抑制。意义：调查结果将为发展提供信息 与社区合作伙伴及其患者合作的未来个人水平干预措施以及一个集群 HIV诊所的随机试验评估临床水平干预的更广泛效率。暴露于IPV的WLWH 是扩大艾滋病毒护理的关键目标。成功的治疗结果取决于 最佳的每日自我管理。该项目借鉴了研究团队的优势，以解决IPV- 健康联系并改善妇女的生活。