Defining intervention targets along pathways from cumulative stress and trauma to alcohol and HIV self-management among young people living with HIV (Project DEFINE)

1感染艾滋病毒的年轻人（YPLWH）艾滋病毒自我管理能力差的风险很高， 2可检测到的病毒载量为88%，对于危险的酒精使用，这可能会对艾滋病毒产生负面影响 3治疗和预防级联。干预措施，以改善自我管理的酒精和 4使用和艾滋病毒护理至关重要，但部分由于未能考虑到 5为发展和文化特点，独特的人口和压力和创伤 六是体现了这些特点。YPLWH在种族、民族和性别方面的比例不成比例 7个少数民族经历更高的慢性和复杂的压力和创伤来源 8一生中此外，还有与以下方面有关的压力和创伤的压迫性来源： 9他们的种族、民族、性和性别认同以及艾滋病毒状况，如歧视， 10微侵犯，以及系统性结构和社会不平等造成的耻辱。虽然 11压力与酒精使用和疾病管理有关， YPLWH之间的12个联系知之甚少。有证据表明， 13可能在这些间接途径中发挥作用。压力与睡眠健康状况不佳有关， 14这可能会影响酒精使用和艾滋病毒的自我管理，通过睡眠不良的影响， 15情绪调节行为调节（例如，决策，抑制控制），是一个核心 16自我管理的组成部分，并可能类似地调解累积之间的关联 17压力和酒精使用。与P01提高自我管理的总体目标一致 在YPLWH中的酒精使用和艾滋病毒护理方面，该项目将从发展和 19个与文化相关的、可修改的干预目标，在累积压力之间的因果途径中 20和自我管理的结果之间的YPLWH，其中大多数是受交叉 21压力和创伤的来源。利用创新的推广方法，我们将招收300名不同的 22名18至29岁的青年工作者完成累积和并发的压力和创伤、睡眠 23健康（即，使用电子睡眠日记的调查和生态瞬时分析[EMA]）， 24情绪和行为调节，以及基线时的物质使用和HIV结果，9和18 25个月此外，少数青少年艾滋病毒携带者不太可能接受筛查或获得现有的 26次发言。在第五年，我们将采用混合方法，与 27名社区成员开发一套经调整的可扩展干预措施工具包 28目标由此产生的知识和工具有可能改善健康结果， 29得不到充分服务的青年的生活质量，他们往往无法从艾滋病毒护理的进步中受益 30通过解决与他们独特相关的因素。

1 Young people living with HIV (YPLWH) are at high risk for poor HIV self-management, with 2 detectable viral load in 88%, and for hazardous alcohol use which can negatively impact the HIV 3 treatment and prevention cascade. Interventions to improve self-management of both alcohol 4 use and HIV care are critical but have had limited success in part due to the failure to account 5 for developmental and cultural characteristics unique to this population and stress and trauma 6 conferred by these characteristics. YPLWH are disproportionately racial, ethnic and sexual 7 minorities who experience higher rates of chronic and complex sources of stress and trauma 8 throughout their lives. Additionally, there are oppressive sources of stress and trauma related to 9 their racial, ethnic, sexual, and gender identities and HIV status, such as discrimination, 10 microaggressions, and stigma as a result of systemic structural and societal inequities. Although 11 stress has been linked to alcohol use and disease management, the pathways underlying these 12 links among YPLWH are poorly understood. Evidence suggests several modifiable factors that 13 may play a role in these indirect pathways. Stress has been associated with poor sleep health, 14 which may impact alcohol use and HIV self-management through the effect that poor sleep has 15 on emotion regulation. Behavioral regulation (e.g., decision-making, inhibitory control), is a core 16 component of self-management and may similarly mediate associations between cumulative 17 stress and alcohol use. Consistent with the overall goal of the P01 to improve self-management 18 of alcohol use and HIV care among YPLWH, this project would define developmentally and 19 culturally relevant, modifiable intervention targets in causal pathways between cumulative stress 20 and self-management outcomes among YPLWH, most of whom are subject to intersectional 21 sources of stress and trauma. Using innovative outreach methods, we will enroll 300 diverse 22 YPLWH age 18-29 to complete surveys of cumulative and intercurrent stress and trauma, sleep 23 health (i.e., survey and ecological momentary analysis [EMA] using an electronic sleep diary), 24 emotion and behavioral regulation, and substance use and HIV outcomes at baseline, 9 and 18 25 months. Further, minority YPLWH are less likely to be screened for or have access to available 26 interventions. In the fifth year, we will use a mixed methods approach in collaboration with 27 community members to develop a toolkit of adapted scalable measures for intervention 28 targeting. The resulting knowledge and tools have the potential to improve health outcomes and 29 quality of life for underserved youth who often may not benefit from advances in HIV care 30 through addressing factors uniquely relevant to them.