Gender Based Violence and HIV Outcomes: Tracking and Treating Mental Illness

基于性别的暴力和艾滋病毒结果：跟踪和治疗精神疾病

• 批准号: 8960533
• 负责人: Susan M. Meffert
• 金额: $ 3.42万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-09 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8960533
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adverse effects; Affect; Africa South of the Sahara; Age; Anxiety Disorders; Award; Awareness; California; Caring; Cause of Death; Chronic Disease; Cognitive Therapy; Cohort Studies; Collaborations; Country; Cross-Sectional Studies; Data; Diagnosis; Dysthymic Disorder; Education; Family; Funding; Gender; Goals; HIV; HIV Infections; Health; Healthcare; Highly Active Antiretroviral Therapy; Income; Individual; Injury; Intervention; Intervention Studies; K-Series Research Career Programs; Kenya; Knowledge; Laboratories; Location; Major Depressive Disorder; Manuals; Mediating; Mediation; Mediator of activation protein; Mental Depression; Mental Health; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mission; Mood Disorders; National Institute of Mental Health; Natural History; Outcome; Participant; Pathway interactions; Pilot Projects; Population; Post-Traumatic Stress Disorders; Province; Psychiatric therapeutic procedure; Psychiatry; Psychotherapy; Public Health; Publishing; Refugees; Reporting; Research; Research Infrastructure; Research Training; Resources; Scientist; Services; Structure; Testing; Time; Training; Trauma; Trauma Research; Treatment Efficacy; Uganda; Victimization; Violence; Viral Load result; Waiting Lists; Woman; Work; base; burden of illness; career; cohort; disability; efficacy testing; experience; improved; interpersonal therapy; longitudinal analysis; minor depressive disorder; novel; physical conditioning; professor; programs; prospective; reproductive; skills; Acquired Immunodeficiency Syndrome; Address; Adherence; Adverse effects; Affect; Africa South of the Sahara; Age; Anxiety Disorders; Award; Awareness; California; Caring; Cause of Death; Chronic Disease; Cognitive Therapy; Cohort Studies; Collaborations; Country; Cross-Sectional Studies; Data; Diagnosis; Dysthymic Disorder; Education; Family; Funding; Gender; Goals; HIV; HIV Infections; Health; Healthcare; Highly Active Antiretroviral Therapy; Income; Individual; Injury; Intervention; Intervention Studies; K-Series Research Career Programs; Kenya; Knowledge; Laboratories; Location; Major Depressive Disorder; Manuals; Mediating; Mediation; Mediator of activation protein; Mental Depression; Mental Health; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mission; Mood Disorders; National Institute of Mental Health; Natural History; Outcome; Participant; Pathway interactions; Pilot Projects; Population; Post-Traumatic Stress Disorders; Province; Psychiatric therapeutic procedure; Psychiatry; Psychotherapy; Public Health; Publishing; Refugees; Reporting; Research; Research Infrastructure; Research Training; Resources; Scientist; Services; Structure; Testing; Time; Training; Trauma; Trauma Research; Treatment Efficacy; Uganda; Victimization; Violence; Viral Load result; Waiting Lists; Woman; Work; base; burden of illness; career; cohort; disability; efficacy testing; experience; improved; interpersonal therapy; longitudinal analysis; minor depressive disorder; novel; physical conditioning; professor; programs; prospective; reproductive; skills

DESCRIPTION (provided by applicant): This is a re-submission of a K23 award for Susan Meffert MD, MPH, Assistant Professor of Psychiatry at UCSF. This career award proposal builds on Dr. Meffert's research with emotionally traumatized populations in Low-and-Middle-Income Countries (LMICs) and proposes research and training goals to focus her work on HIV-infected (HIV+) women exposed to Gender-Based Violence (GBV) (HIV+GBV+). Despite knowledge that GBV has profound adverse effects on physical health (exceeding direct injury),1-4 and that GBV is highly prevalent among HIV+ women,5,6 little is known about how GBV affects HIV outcomes. In cross sectional analysis, GBV is associated with detectable viral load (VL) and decreased CD4 count.7 Mental health sequeale of GBV, including Posttraumatic Stress Disorder (PTSD) and depression, are theorized mediators of the relationships between violence, HAART adherence and poor HIV outcomes.7,8 However, without a data-driven understanding of these relationships, we are unable to develop psychiatric treatments that effectively improve the overall health of the extraordinary numbers of HIV+ women exposed to GBV. The proposal addresses this crucial knowledge gap using a large longitudinal cohort study of HIV+ women and a pilot intervention with HIV+GBV+ women in a high burden region. Mentored by internationally recognized scientists, I propose three research aims: Aim 1 is a longitudinal analysis of GBV, HIV outcomes and mental health mediators in the largest prospective cohort study of HIV- affected women (Women's Interagency HIV Study [WIHS]). My co-mentor, Ruth Greenblatt, MD, is the N. California PI for the WIHS study. Building on my work with the UCSF-Family AIDS Care Education and Services (FACES) program in a high HIV region of Kenya, Aim 2 is an adaptation of an established mental health treatment (Interpersonal Psychotherapy [IPT]) for depression and PTSD among HIV+GBV+ women at FACES. Aim 3 is a pilot study assessing feasibility and acceptability of the adapted IPT. UCSF-FACES is a PEPFAR-funded care and research collaboration serving more than 90,000 HIV+ individuals in western Kenya. FACES has robust research infrastructure and I have an established, highly productive research team onsite. This proposal is significant because it will generate the first longitudinal analysis of GBV, HIV outcomes and mental disorders, and the first mental health intervention adapted and piloted for HIV+GBV+ women. These studies may substantially improve women's HIV programs by addressing a largely untapped mental health pathway affecting HIV outcomes among GBV+ women and developing/piloting a psychiatric treatment for HIV+GBV+ women. These research aims are tightly integrated with my training goals: (1) Longitudinal analytic methods in HIV; (2) IPT adaptation and (3) Mental health intervention research. These studies will generate preliminary findings for an R01-funded intervention testing the efficacy of adapted IPT for the effects of GBV on psychiatric and HIV outcomes.

描述（由申请人提供）：这是UCSF精神病学助理教授Susan Meffert MD的K23奖。该职业奖提案是基于梅弗特博士在低中间和中等收入国家（LMIC）的情感创伤人群的研究，并提出研究和培训目标，将她的工作集中在受性别基于性别的暴力（GBV）（GBV）（HIV+GBV+）的HIV感染（HIV+）妇女上。尽管知道GBV对身体健康有深远的不利影响（超过直接损伤），但在HIV+女性中GBV非常普遍，但对于GBV如何影响HIV结果，有5,6鲜为人知。在横截面分析中，GBV与可检测的病毒载荷（VL）和CD4计数降低有关。7精神健康的GBV续集，包括创伤后应激障碍（PTSD）和抑郁症，理论上是暴力，HAART坚持和不良HIV的艾滋病毒效果之间的关系之间的关系的理论化学家。暴露于GBV的艾滋病毒+妇女数量的非凡。该提案通过对高负担地区的HIV+女性和HIV+ GBV+妇女进行的大量纵向队列研究解决了这一关键的知识差距。在国际公认的科学家的指导下，我提出了三个研究目的：AIM 1是对HIV受HIV受影响的妇女的最大前瞻性队列研究（妇女妇女跨性别HIV研究[WIHS]）的GBV，HIV结果和心理健康媒介的纵向分析。我的同事，医学博士露丝·格林布拉特（Ruth Greenblatt）是WIHS研究的N. California Pi。在我在肯尼亚高艾滋病毒地区的UCSF家庭艾滋病护理教育和服务（FACES）计划的基础上，AIM 2是对抑郁症的既定心理健康治疗（IPT]）的改编，用于抑郁症和PTSD，而PTSD的HIV+ GBV+妇女的脸部适应了抑郁症。 AIM 3是一项试点研究，评估了适应IPT的可行性和可接受性。 UCSF-Faces是一项由PEPFAR资助的护理和研究合作，在肯尼亚西部为90,000多名HIV+个人提供服务。面孔具有强大的研究基础设施，我拥有一个建立的，高产的研究团队现场。该提案很重要，因为它将对GBV，HIV结局和精神障碍进行首次纵向分析，以及针对HIV+ GBV+女性的首次精神健康干预措施。这些研究可能会通过解决一项在很大程度上尚未开发的心理健康途径，从而影响妇女的艾滋病毒计划，从而影响GBV+妇女中的艾滋病毒结局，并开发/驾驶针对HIV+ GBV+妇女的精神病治疗。这些研究目标与我的培训目标紧密整合：（1）艾滋病毒中的纵向分析方法； （2）IPT适应和（3）心理健康干预研究。这些研究将为R01资助的干预措施产生初步发现，以测试适应IPT对GBV对精神病和HIV结果的影响的功效。