Addressing Trauma from Interpersonal Violence through a Web-based Peer Navigation-Social Support Intervention to Improve ART Adherence among Women

通过基于网络的同伴导航-社会支持干预来解决人际暴力造成的创伤，以提高妇女对 ART 的依从性

• 批准号: 10275346
• 负责人: Jamila Kinshasa Stockman
• 金额: $ 79.85万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10275346
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Adult; Affect; Affective; California; Caring; Clinic; Collection; Color; Continuity of Patient Care; County; Distress; Effectiveness; Emotions; Enrollment; Epidemic; Goals; HIV; Hair; Individual; Interpersonal Violence; Intervention; Link; Mediator of activation protein; Medical; Mental Depression; Mental Health; Methods; Moods; Online Systems; Outcome; Participant; Pathway interactions; Personal Satisfaction; Persons; Population; Post-Traumatic Stress Disorders; Proliferating; Randomized; Randomized Controlled Trials; Recording of previous events; Research; Resources; Sampling; Self Care; Self Efficacy; Services; Sexual abuse; Social support; Structure; Substance Use Disorder; Substance abuse problem; Support Groups; Surveys; Symptoms; Technology; Testing; Transportation; Trauma; Treatment outcome; Triad Acrylic Resin; Violence; Viral; Woman; antiretroviral therapy; arm; base; cis-female; coping; efficacy evaluation; emotion regulation; emotional abuse; experience; follow up assessment; implementation cost; implementation intervention; improved; intimate partner violence; men; new technology; peer; physical abuse; preventive intervention; programs; psychoeducation; psychologic; recruit; skills; social stigma; social structure; substance use; theories; therapy adherence; therapy design; transgender women; trauma exposure; treatment arm; violence exposure; web site

PROJECT SUMMARY In the US, women living with HIV/AIDS (WLHA) are less likely to be adherent to antiretroviral therapy (ART) and virally suppressed compared to men living with HIV/AIDS. Concurrently, WLHA experience high rates of interpersonal violence – physical, sexual, and/or psychological abuse in adulthood – which often results in trauma (e.g., post-traumatic stress disorder [PTSD]) and other adverse mental health, further contributing to ART non-adherence. Additionally, the confluence of syndemic adverse mental health, substance use, and socio-structural factors (e.g., HIV stigma, medical mistrust) further contribute to poor HIV outcomes. Social support through peer navigation and networks has been shown to counter these effects and improve HIV outcomes among WLHA. Likewise, psychoeducation addressing affective distress to improve mood and emotion management and relationship skills has been shown to reduce PTSD and depression. However, limited resources at HIV service agencies combined with socio-structural barriers (e.g., lack of transportation, competing priorities) impede the potential effectiveness of in-person peer navigation. A scalable and sustainable solution is the use of technology in the form of web-based video interaction. To that end, we developed and pilot tested a 4-month web-based, trauma-informed peer navigation-psychoeducation social support intervention among WLHA affected by interpersonal violence and syndemic adverse mental health and/or substance use. We demonstrated feasibility, acceptability, preliminary improvements in ART adherence, PTSD symptoms, coping self-efficacy, and social support. Building on these promising pilot findings, we propose to conduct a randomized controlled trial of Women SHINE to improve ART adherence among WLHA affected by adulthood interpersonal violence in California. Participants will be randomized to either: a) the intervention arm (n=180) where women will receive a 4-month program comprised of video-based peer navigation support via one-on-one sessions and 7 psychoeducation weekly support group sessions, and access to a static Women SHINE website with statewide resources for HIV care, interpersonal violence, trauma, mental health, and substance use; or b) the control arm (n=180) where women will receive a single group session on self-care and well-being, with access to the static Women SHINE website. Women will complete video-based survey assessments and mailed hair sample self-collection at baseline, 4-, 8-, and 12- months post-randomization. Compared to the control arm, we will determine if Women SHINE is associated with improvements in ART adherence (Aim 1) and PTSD symptoms and emotion regulation (Aim 2). We will also examine individual (e.g., self-efficacy for coping, social support networks) and socio-structural (e.g., HIV stigma, medical mistrust) mechanisms of change in the efficacy of Women SHINE (Aim 3). If efficacious, we will conduct subsequent research to determine effective and feasible methods for intervention implementation nationwide to improve HIV outcomes among WLHA.

项目概要 在美国，感染艾滋病毒/艾滋病 (WLHA) 的女性不太可能坚持抗逆转录病毒治疗 (ART) 与感染艾滋病毒/艾滋病的男性相比，病毒受到抑制。同时，WLHA 的发病率很高 人际暴力——成年后的身体、性和/或心理虐待——这通常会导致 创伤（例如，创伤后应激障碍 [PTSD]）和其他不良心理健康，进一步导致 不遵守 ART。此外，综合征性不良心理健康、药物滥用和 社会结构因素（例如，艾滋病毒耻辱、医疗不信任）进一步导致艾滋病毒结果不佳。社会的 事实证明，通过同伴导航和网络提供的支持可以抵消这些影响并改善艾滋病毒 WLHA 之间的结果。同样，通过心理教育解决情感困扰以改善情绪和 情绪管理和人际关系技巧已被证明可以减少创伤后应激障碍和抑郁症。然而， 艾滋病毒服务机构资源有限，加上社会结构障碍（例如缺乏交通、 相互竞争的优先事项）阻碍了面对面同行导航的潜在有效性。一个可扩展且 可持续的解决方案是使用基于网络的视频交互形式的技术。为此，我们 开发并试点测试了一个为期 4 个月的基于网络的、创伤知情的同伴导航-心理教育社交系统 支持对受人际暴力和流行病不良心理健康影响的 WLHA 进行干预 和/或物质使用。我们证明了 ART 依从性的可行性、可接受性和初步改进， 创伤后应激障碍症状、应对自我效能和社会支持。基于这些有希望的试点结果，我们 提议开展一项 Women SHINE 随机对照试验，以提高 WLHA 的 ART 依从性 在加利福尼亚州受到成年人际暴力的影响。参与者将被随机分配到：a) 干预组（n=180），妇女将接受为期 4 个月的计划，其中包括基于视频的同伴 通过一对一会议和 7 次心理教育每周支持小组会议提供导航支持，以及 访问静态 Women SHINE 网站，其中包含全州范围内的艾滋病毒护理、人际暴力、 创伤、心理健康和药物滥用；或 b) 控制臂 (n=180)，其中女性将接受单一 关于自我保健和福祉的小组会议，可访问静态 Women SHINE 网站。女人会 完成基于视频的调查评估并在基线、4、8 和 12 时自行收集邮寄的头发样本 随机化后几个月。与控制臂相比，我们将确定 Women SHINE 是否相关 改善 ART 依从性（目标 1）以及 PTSD 症状和情绪调节（目标 2）。我们将 还检查个人（例如，应对的自我效能、社会支持网络）和社会结构（例如，艾滋病毒 耻辱、医疗不信任）Women SHINE 功效变化的机制（目标 3）。如果有效的话，我们 将进行后续研究以确定有效可行的干预实施方法 在全国范围内改善 WLHA 的艾滋病毒结果。