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：超过一半的女性艾滋病毒感染者（WLWH）曾遭受亲密伴侣暴力（IPV）， 比全国妇女高12至32倍。IPV暴露（与非暴露）的妇女有显着 对艾滋病毒护理的参与程度较低，抑制病毒的可能性较低。虽然集成了IPV-HIV 虽然目前存在各种干预措施，但这些措施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。 在这一高风险人群中，关注日常细节至关重要-暴露于IPV的WLWH面临独特的挑战 管理艾滋病毒的日常问题。目的：本研究的主要目的是了解暴露于 艾滋病毒/艾滋病影响到妇女日常自我管理艾滋病毒和参与艾滋病毒纵向护理的能力。 该研究还将评估IPV健康重点筛查、简短干预和转诊护理的效果 （SBIRT）协议相比，标准的护理对妇女的艾滋病毒护理参与。方法：315例成人 将招募感染艾滋病毒和曾经接触过IPV的妇女。“被包养”的妇女将被征入伍 通过瑞安·怀特资助的艾滋病诊所“脱离护理”的妇女将通过康涅狄格州招募 公共卫生部疾病干预专家外展工作者。注册后， 基线访谈，妇女将完成28天的抗逆转录病毒（ARV）依从性每日数据收集， 潜在风险（物质使用，抑郁/创伤症状和IPV）和保护性（情绪调节，自我调节， 功效）因素。在第3个月随访研究访谈时，女性将随机接受 以IPV健康为中心的SBIRT或标准治疗。女性将在第6个月完成退出研究访谈。旨在 (1)确定每日抗逆转录病毒治疗依从性的近端决定因素，并确定是否有保护性因素介导， 暴力特征温和的协会;（2）表征潜在的亚组WLWH的基础上， 每日抗逆转录病毒治疗依从性的近端决定因素，并确定其与保持护理和病毒感染的关系。 镇压(3)测试IPV-健康干预与标准治疗对ARV的影响 依从性、保持护理和病毒抑制。意义：研究结果将为发展提供信息， 与社区合作伙伴及其患者和一个集群合作， 艾滋病毒诊所的随机试验，以评估临床水平干预的更广泛疗效。IPV暴露的WLWH 是扩大艾滋病毒护理连续性的关键目标人群。成功的治疗结果取决于 最佳的日常自我管理本项目利用研究团队的优势，解决IPV问题， 健康联系，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.