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：
9063619
负责人：
KATHLEEN J SIKKEMA
金额：
$ 15.74万
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 2018-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9063619
关键词：
Acquired Immunodeficiency Syndrome Address Adherence Adult 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 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 South African 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 health care service high risk improved men patient population prevent psychologic 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）：南非感染艾滋病毒的妇女报告性创伤发生率很高，这对她们的心理健康产生负面影响，并可能影响艾滋病毒护理的参与（保留护理和坚持抗逆转录病毒治疗）和危险行为。解决性创伤造成的创伤性压力可以改善这些与艾滋病毒相关的结果，进而可以通过抑制病毒和减少艾滋病毒危险行为来预防艾滋病毒传播。在美国对有创伤史的艾滋病毒感染者进行的干预研究表明，应对方法，特别是减少使用回避应对策略的方法，可以有效减少创伤性压力和改善健康行为。尽管南非面临艾滋病毒和性暴力的双重流行，但创伤治疗尚未很好地融入艾滋病毒护理环境中。拟议的为期 3 年的研究将开发并试点测试一种名为 ImpACT（改善创伤后艾滋病护理）的干预措施，以减少回避应对、创伤性压力和危险行为，并提高护理参与度。该干预措施将在公共 ART 诊所进行，针对处于开始 ART 关键时期的女性，以最大限度地提高参与护理的影响。与研究诊所的工作人员、提供者和感染 HIV 的女性患者进行定性数据收集，将收集有关 ImpACT 内容和实施以及研究方案关键方面的反馈。然后，ImpACT 将在 60 名新加入 ART 且有性创伤史和创伤应激升高的女性中进行试点。参与者将被随机分配到控制条件（标准护理或 SoC：所有在诊所开始 ART 的患者需要 3 次依从性咨询课程）或干预条件（SoC + ImpACT），并将在基线、3 和 6 时完成评估随机化后几个月，在研究期结束时从医疗记录中提取护理参与数据。该研究有三个具体目标：1）制定一个简短且可扩展的应对干预措施，以便在南非艾滋病毒护理环境中为有性创伤史的妇女提供服务； 2) 建立稳健的随机对照试验的实验方案的方法学细节； 3) 对 60 名有性创伤史且正在开始 ART 的 HIV 感染妇女进行 ImpACT 干预试点测试，以确定 HIV 护理环境中的可行性和可接受性，并探讨对回避应对、创伤性压力、参与护理和艾滋病毒风险行为的影响。完成本研究的目标是制定一个与南非艾滋病毒感染妇女文化相关的结构化干预课程、适合南非护理环境的完整实验方案以及可行性、可接受性和目标的数据结果。这些产品可用于为 R01 应用程序提供信息，以对 ImpACT 干预措施进行严格评估。我们相信，这项开发工作将显着提高更大规模随机对照试验的成功概率。