Pilot trial of an intervention to increase HIV engagement and reduce Intimate Partner Violence among Black women living with HIV

旨在提高感染艾滋病毒的黑人妇女的艾滋病毒参与度并减少亲密伴侣暴力的干预措施试点试验

• 批准号: 10626954
• 负责人: Kamila ANISE Alexander
• 金额: $ 20.47万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10626954
• 关键词: Address; Adherence; Affect; Appointment; Attention; Behavior Therapy; Behavioral; Birth; Black race; Caring; Case Management; Child Sexual Abuse; Chronic; Cognitive; Cognitive Therapy; Communication; Communities; Community Health Aides; Diagnosis; Disclosure; Disparity; Documentation; Educational process of instructing; Enrollment; Epidemic; Exposure to; Female; Focus Groups; Fright; Gender; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Impairment; Intervention; Intervention Studies; Intervention Trial; Interview; Knowledge; Life; Link; Measures; Medical Records; Mental Health; Modeling; Newly Diagnosed; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Pilot Projects; Problem Solving; Process; Public Health; Quality of life; Randomized; Recommendation; Research; Resources; Rewards; Role; Safety; Schedule; Social support; Source; Spirituality; Stigmatization; Stress; Techniques; Testing; Thinking; Time; Training; Trauma; United States Health Resources and Services Administration; Viral; Viral Load result; Visit; Woman; acceptability and feasibility; aged; antiretroviral therapy; arm; black women; care providers; cisgender; clinical care; community burden; community organizations; coping; design; environmental stressor; experience; follow up assessment; follow-up; help-seeking behavior; improved; inclusion criteria; innovation; intervention refinement; intimate partner violence; medication compliance; physical conditioning; pilot trial; prevent; programs; promote resilience; psychologic; racial disparity; resilience; safety net; self reliance; sex; skills; social stigma; social stressor; therapy design; violence exposure

Black women living with HIV (LWH) continue to experience disparities in exposure to intimate partner violence (IPV) and sub-optimal HIV care engagement. Black women LWH are twice as likely to experience IPV than non-HIV infected Black women. IPV experiences among Black women LWH are associated with decreased access to social support resources and impaired mental and physical health. Many Black women LWH and exposed to IPV also experience chronic exposure to internalized and anticipated stigmas. HIV-related stigma is associated with low rates of HIV care engagement due to fears of disclosure. While IPV-related stigma can prevent women from planning for safety or engaging informal or formal resources. There has been limited attention to the role of IPV or the effects of stigma as a barrier to Black women engaging in HIV care. Cognitive behavioral approaches (CBA) are efficacious to reducing stigma, improving IPV safety strategies, and increasing HIV care engagement, yet interventions designed for Black women LWH and experiencing IPV are lacking. Furthermore, few CBA interventions leverage the existing resilience of Black women LWH using a sources of strength framework. The overarching aim of this research is to conduct: a) component testing of an intervention among Black women with lived experiences of HIV and IPV; and b) a pilot study to evaluate acceptability, feasibility and preliminary efficacy of a 7-session small group-based CBA intervention to reduce HIV and IPV stigma and subsequently increase IPV safety strategies and HIV care engagement. The intervention uses a mnemonic (COPE) to teach techniques to appraise social and environmental stressors which includes real and perceived HIV and IPV stigma, and strategies for altering distorted thinking, problem- solving, bolstering positive social support, and scheduling safety strategies linked to rewards. COPE is delivered by a trained community health worker, which allows for scalability. We will enroll and randomize 80 IPV-exposed Black women LWH into the experimental CBA or control condition. Inclusion criteria are: (a) self- report female sex at birth, (b) self-report Black race, (c) aged 18 to 44 (d) documentation of HIV positive status confirmed with Oraquick test, (e) recent IPV exposure (12 months) as measured by HARK score >=1, (f) self- report <=1 HIV care appointment in previous 12 months. All participants will complete an immediate post- condition, 3 and 6-month follow-up assessments. The overall impact of this innovative intervention is high: it addresses the impact of violence exposure on HIV care engagement among Black women LWH, a priority of the NHAS. The proposed study is relevant to the persistent HIV epidemic that disproportionately impacts Black women LWH. The study intervention is scalable and easily implemented by community-based organizations and health departments.

感染艾滋病毒的黑人女性 (LWH) 在遭受亲密伴侣暴力方面仍然存在差异 (IPV) 和次优的艾滋病毒护理参与度。黑人女性 LWH 经历 IPV 的可能性是黑人女性的两倍 未感染艾滋病毒的黑人女性。黑人女性 LWH 的 IPV 经历与体重下降有关 获得社会支持资源和身心健康受损。许多黑人女性长身高和 接触 IPV 也会长期遭受内在的和预期的耻辱。与艾滋病毒相关的耻辱 由于担心信息披露，艾滋病毒护理参与率较低。虽然与 IPV 相关的耻辱可以 阻止妇女进行安全规划或利用非正式或正式资源。已经有限制了 关注 IPV 的作用或耻辱感作为黑人妇女参与艾滋病毒护理的障碍的影响。 认知行为方法 (CBA) 可有效减少耻辱、改善 IPV 安全策略、 并增加艾滋病毒护理参与度，但为黑人女性 LWH 和经历 IPV 设计的干预措施 缺乏。此外，很少有 CBA 干预措施能够利用黑人妇女 LWH 的现有弹性 力量来源框架。本研究的总体目标是进行： a) 对有艾滋病毒和 IPV 生活经历的黑人妇女进行干预； b) 一项试点研究来评估 为期 7 次的小组 CBA 干预措施的可接受性、可行性和初步效果，以减少 HIV 和 IPV 耻辱感，随后增加 IPV 安全策略和 HIV 护理参与度。这 干预使用助记符（COPE）来教授评估社会和环境压力源的技术 其中包括真实的和感知到的 HIV 和 IPV 耻辱，以及改变扭曲思维、问题的策略 解决、加强积极的社会支持以及安排与奖励相关的安全策略。应对能力是 由训练有素的社区卫生工作者提供，具有可扩展性。我们将随机招募 80 名 暴露于 IPV 的黑人女性 LWH 进入实验 CBA 或对照条件。纳入标准是： (a) 自我 报告出生时的女性性别，(b) 自我报告黑人种族，(c) 18 至 44 岁 (d) HIV 阳性状况记录 通过 Oraquick 测试确认，(e) 最近的 IPV 暴露（12 个月），通过 HARK 评分 >=1 测量，(f) 自我 报告过去 12 个月内 <=1 次 HIV 护理预约。所有参与者将立即完成后 状况、3 个月和 6 个月的随访评估。这种创新干预措施的总体影响很大： 解决暴力暴露对黑人妇女 LWH 参与艾滋病毒护理的影响，这是 NHAS。拟议的研究与持续的艾滋病毒流行有关，该流行病对 黑人女性 LWH。该研究干预措施具有可扩展性，并且易于由社区实施 组织和卫生部门。