Intervening with Haitian HIV+ Alcohol Abusers: An Environmental Psychosocial Fram

对海地艾滋病毒酗酒者进行干预：环境心理社会框架

• 批准号: 7878808
• 负责人: ROBERT Michael MALOW
• 金额: $ 43.59万
• 依托单位: FLORIDA INTERNATIONAL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-30 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7878808
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Acute; Address; Adherence; Adult; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Area; Behavior; Behavioral; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Chronic; Civil Disorders; Clinic; Clinical; Clinical Research; Cognitive; Cognitive Therapy; Cohort Studies; Collaborations; Communicable Diseases; Communication; Communities; Comorbidity; Conflict (Psychology); Consensus; Coping Skills; Country; Developing Countries; Dimensions; Disadvantaged; Discipline; Drug user; Economics; Elements; Environment; Epidemic; Equilibrium; Evidence based intervention; Female; Funding; Gap Junctions; Grant; Guidelines; HIV; Haiti; Health; Health Promotion; Health behavior; Healthcare; Hour; Housing; Individual; Institution; International; Intervention; Kaposi Sarcoma; Laws; Life; Low Income Population; Measurement; Mediating; Modeling; Motivation; National Institute on Alcohol Abuse and Alcoholism; Opportunistic Infections; Outcome; Patients; Pharmaceutical Preparations; Pilot Projects; Play; Policies; Population; Population Heterogeneity; Population Intervention; Poverty; Prevention; Preventive; Preventive Intervention; Probability; Problem Solving; Provider; Psychiatric Social Work; Randomized; Research; Research Design; Research Personnel; Research Training; Resources; Risk; Risk Reduction; Role; Rural Community; Safe Sex; Sampling; Self Management; Sentinel; Sexual Transmission; Social support; Specific qualifier value; Staging; Stress; Stress and Coping; System; Testing; Therapeutic; Time; To specify; Translating; Translational Research; Translations; Trauma; Treatment Factor; Trust; United States National Institutes of Health; Urban Population; Urbanization; Violence; Virus; Work; alcohol abstinence; alcohol and other drug; alcohol intervention; base; clinical practice; clinical research site; community based treatment; community setting; condoms; contextual factors; coping; design; disorder control; evidence base; experience; follow-up; high risk; high risk behavior; improved; intervention effect; knowledge base; male; medication compliance; parent grant; primary outcome; psychosocial; public health relevance; randomized trial; safer sex; scale up; secondary outcome; sex risk; skills; social; stress management; success; theories; transmission process

DESCRIPTION (provided by applicant): The proposed study is an adaptation and randomized trial of a Cognitive-Behavioral Stress Management (CBSM) intervention for simultaneously enhancing safer sex practices, adherence to ARV medication, and reducing alcohol or other drugs (AOD) use, in a predominantly poor urban population in Haiti. With our on- site clinical research partner, the GHESKIO Centers, a key focus will be how HIV intervention outcomes are influenced by Environmental and PsychoSocial (Env-Psy-Soc) factors. Performing this study in Haiti with GHESKIO presents a unique opportunity to contribute an EnvPsySoc dimension to the HIV/AIDS prevention and treatment scale-up that is ongoing there and in the region. GHESKIO is unique and unparalleled in Haiti and the region as a socially trusted infectious disease control institution that has been there since the discovery of the HIV virus and that has successfully adapted an academically disciplined HIV/AIDS clinical research and training model into the urban and rural communities of Haiti. GHESKIO operates using an integrated care model similar to a typical U.S. VA center, and serves a population reflective of the fault lines of the epidemic in resource-constrained countries: poverty and disempowerment, the trauma and violence of chaotic urbanization and frequent civil disorder and inadequate rule of law. Using the vehicle of CBSM, a potentially efficacious prevention intervention for reducing HIV transmission risk among People Living with HIV (PLWH) in this clinical venue enhances the probability of success. CBSM-A, the adapted intervention to be evaluated, is based on an NIH pilot study in Haiti that was guided by Information-Motivation-Behavior (IMB) theory. It is a small-group design for HIV+ AOD using populations, which also addresses their cognitive/self management and coping barriers that may impede sustainable outcomes, particularly in resource-constrained settings as Haiti. HLM/SEM analyses will be used to explore adherence to safer sex and ARV medication guidelines as well as how intervention effects are influenced by traditional IMB variables, AOD use, and EnvPsySoc factors. The proposed project responds to the NIH priority on integrating environmental-psychosocial research and on bridging clinical research and practice, by adapting and translating effective research-based intervention strategies for the "real world" conditions faced by community based providers. If successful, this research will present an HIV intervention strategy that can be practically implemented for HIV+ adults with high risk behaviors (alcohol use and unsafe sexual practices) in Haiti and other resource-constrained settings, while advancing the knowledge base of how to tailor interventions for such settings. PUBLIC HEALTH RELEVANCE: The proposed study is an adaptation and randomized trial of a Cognitive-Behavioral Stress Management (CBSM) intervention that will enhance safer sex practices, adherence to ARV medication, and reduce alcohol or other drugs (AOD) use in People Living with HIV (PLWH) in a high risk, poor, urban center in Haiti. A key focus of the study will be how HIV intervention outcomes are influenced by a set of alcohol-related Environmental and PsychoSocial (Env-Psy-Soc) factors. If successful, this research will present an HIV intervention strategy that can be practically implemented for HIV+ adults with high risk behaviors, including alcohol use, in Haiti and other resource-constrained settings, while advancing the knowledge base of how to tailor interventions for such settings.

描述（由申请人提供）：拟议的研究是对认知行为压力管理（CBSM）干预的适应和随机试验，以同时增强安全性疗法，遵守ARV药物，并减少酒精或其他药物（AOD）的使用（AOD），在海蒂的高等城市人群中使用，主要贫困的城市人群中的主要贫困较差。与我们的现场临床研究合作伙伴，Gheskio中心，重点是如何受到环境和社会心理（ENV-PSY-SOC）因素的影响HIV干预结果。与Gheskio一起在海地进行这项研究提供了一个独特的机会，可以为艾滋病毒/艾滋病的预防和治疗规模贡献在那里和该地区正在进行的范围。自从发现HIV病毒以来，Gheskio在海地和该地区是一个社会信任的传染病控制机构，它一直是一个受社会信任的传染病控制机构的独特之处，并且已经成功地改编了一个学术纪律的HIV/AIDS临床研究和培训模型，使其适应了海地城市和农村社区。 Gheskio使用类似于典型的美国弗吉尼亚中心的综合护理模型运作，并为资源受限国家中流行病的断层线路提供服务：贫困和无能为力，混乱的城市化的创伤和暴力频繁的民用障碍和不足的法律规则。使用CBSM的车辆，在该临床场所中，一种潜在的有效预防干预措施可降低HIV（PLWH）患者的HIV传播风险，从而提高了成功的可能性。 CBSM-A是用于评估的改编干预措施，它基于海地的NIH试点研究，该研究以信息动机行为（IMB）理论为指导。它是使用人群的艾滋病毒+ AOD的小组设计，它还解决了他们的认知/自我管理和应对障碍，可能阻碍了可持续的结果，尤其是在海地的资源约束环境中。 HLM/SEM分析将用于探索对更安全的性别和ARV药物指南的依从性，以及如何受到传统IMB变量，AOD使用和EnvPSYSOC因素的影响。拟议的项目通过调整和翻译有效的基于研究的干预策略对基于社区的提供者面临的“现实世界”条件的有效的基于研究的干预策略来回应NIH的优先事项，并在整合环境心理社会研究和桥接临床研究和实践方面做出了回应。如果成功的话，这项研究将提出一种艾滋病毒干预策略，该策略实际上可以针对海地和其他资源约束环境的高风险行为（酒精使用和不安全的性行为）的艾滋病毒+成年人实施，同时促进了如何为这种情况量身定制干预措施的知识库。 公共卫生相关性：拟议的研究是认知行为压力管理（CBSM）干预措施的适应和随机试验，该干预将增强更安全的性实践，对ARV药物的遵守，减少酒精或其他药物（AOD）在HIV（PLWH）中使用的人（PLWH）在高风险中，高风险，贫困，不良的，在Haiti中的Urban中心。该研究的重点将是HIV干预结果如何受到与酒精相关的环境和社会心理（ENV-PSY-SOC）因素的影响。如果成功的话，这项研究将提出一种艾滋病毒干预策略，该策略实际上可以针对具有高风险行为的艾滋病毒+成年人（包括饮酒，海地和其他资源约束的环境）实施，同时推进了如何量身定制这种情况的知识库。