Identifying Modifiable Risk and Protective Processes at the Day-Level that Predict HIV Care Outcomes Among Women Exposed to Partner Violence

项目摘要 问题：超过一半的艾滋病毒携带者(WLWH)曾接触过亲密伴侣暴力(IPV)， 这一比例是全国女性的12到32倍。接触过IPV的(与未接触过的)女性相比， 对艾滋病毒护理的参与度较低，病毒抑制的可能性较低。尽管整合了IPV-HIV 虽然存在干预措施，但它们侧重于减少艾滋病毒风险，而这与艾滋病毒的日常管理关系不大。 在这个高危人群中，对日常细节的关注至关重要-暴露在IPV中的WLWH面临着独特的挑战 管理艾滋病毒的日常方面。目的：这项研究的主要目的是了解暴露于 IPV影响妇女每天自我管理艾滋病毒和进行纵向艾滋病毒护理的能力。 这项研究还将评估以IPV-健康为重点的筛查、简短干预和转诊护理的效果 (SBIRT)方案与妇女艾滋病毒护理参与度的护理标准的比较。方法：315名成人 艾滋病毒携带者和曾经接触过IPV的妇女将被登记。“在看护中”的女性将被招募 通过瑞安·怀特资助的艾滋病诊所。将通过康涅狄格州招募“脱离护理”的女性 公共卫生署疾病干预专家外展工作人员。在注册后和 基线访谈，女性将完成28天的每日抗逆转录病毒(ARV)依从性数据收集和 潜在风险(药物使用、抑郁/创伤症状和IPV)和保护性(情绪调节、自我 功效)因素。在第3个月的后续研究访谈中，女性将被随机选择接受 IPV-以健康为重点的SBIRT或标准护理。女性将在6个月完成离职研究面试。 (1)确定每日ARV依从性的近端决定因素，并确定保护性因素是否中介和 暴力特征适中的关联性；(2)WLWH潜在亚群的特征 每日ARV依从性的近端决定因素，并确定它们与护理和病毒滞留的关系 压制。(3)测试IPV健康干预的效果，并与ARV的护理标准进行比较 依从性、保持性和病毒抑制。意义：调查结果将为发展 与社区合作伙伴及其患者和集群合作，未来进行个人层面的干预 HIV诊所的随机试验，以评估临床层面干预的更广泛疗效。IPV暴露的WLWH 是扩大艾滋病毒护理连续体的关键目标人群。成功的治疗结果取决于 最佳的日常自我管理。这个项目利用研究团队的优势来应对IPV- 健康连接和改善妇女的生活。

Project Summary Problem: Over half of women living with HIV (WLWH) have been exposed to intimate partner violence (IPV), a rate 12 to 32 times higher than women nationally. IPV-exposed (vs. non-exposed) women have significantly poorer engagement in HIV care and lower likelihood of viral suppression. Though integrated IPV-HIV interventions exist, they focus on HIV risk reduction, which is less relevant to managing HIV day-to-day. Attention to daily details is critical in this high-risk population - IPV-exposed WLWH face unique challenges managing daily aspects of HIV. Purpose: The main purpose of this study is to understand how exposure to IPV affects women's abilities to self-manage their HIV on a daily basis and to engage in longitudinal HIV care. The study will also evaluate the effect of an IPV-health focused screening, brief intervention and referral to care (SBIRT) protocol compared to standard of care on women's HIV care engagement. Methods: 315 adult women living with HIV and ever exposed to IPV will be enrolled. Women who are “in-care” will be recruited through Ryan White-funded HIV clinics. Women who are “out-of-care” will be recruited through Connecticut Department of Public Health Disease Intervention Specialist outreach workers. After enrollment and a baseline interview, women will complete 28 days of daily data collection on antiretroviral (ARV) adherence and potential risk (substance use, depression/trauma symptoms, and IPV) and protective (emotion regulation, self- efficacy) factors. At the month 3 follow-up study interview, women will be randomized to receive either an IPV-health focused SBIRT or standard of care. Women will complete an exit study interview at month 6. Aims (1) To identify proximal determinants of daily ARV adherence and determine if protective factors mediate and violence characteristics moderate associations; (2) To characterize latent subgroups of WLWH based on proximal determinants of daily ARV adherence and determine their relationship to retention in care and viral suppression. (3) To test the effects of an IPV-health intervention, compared to standard of care on ARV adherence, retention in care and viral suppression. Significance: Findings will inform the development of future individual-level interventions in collaboration with community partners and their patients and a cluster randomized trial of HIV clinics to assess the broader efficacy of a clinic-level intervention. IPV-exposed WLWH are a key target population for scaling up the HIV care continuum. Successful treatment outcomes hinge on optimal daily self-management. This project draws on the strengths of the study team to address the IPV- health connection and improve the lives of women.