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

项目概要 问题：超过一半的艾滋病毒感染者 (WLWH) 遭受过亲密伴侣暴力 (IPV)， 比全国女性高出 12 至 32 倍。接触过 IPV（与未接触过 IPV）的女性显着 对艾滋病毒护理的参与程度较低，病毒抑制的可能性较低。虽然整合了 IPV-HIV 尽管存在干预措施，但它们的重点是降低艾滋病毒风险，这与日常管理艾滋病毒的相关性较小。 对于这一高危人群，关注日常细节至关重要 - 暴露于 IPV 的 WLWH 面临着独特的挑战 管理艾滋病毒的日常方面。目的：本研究的主要目的是了解如何接触 IPV 影响女性日常自我管理艾滋病毒和参与纵向艾滋病毒护理的能力。 该研究还将评估以 IPV 健康为重点的筛查、简短干预和转诊护理的效果 (SBIRT) 方案与女性艾滋病毒护理参与度护理标准的比较。方法：315名成人 感染艾滋病毒并曾经接触过 IPV 的女性将被纳入其中。将招募“受照顾”的女性 通过 Ryan White 资助的艾滋病毒诊所。 “失聪”的女性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人员。注册后并 基线访谈中，女性将完成 28 天的每日抗逆转录病毒 (ARV) 依从性数据收集， 潜在风险（药物使用、抑郁/创伤症状和 IPV）和保护性（情绪调节、自我保护） 功效）因素。在第 3 个月的后续研究访谈中，女性将被随机分配接受 以 IPV 健康为重点的 SBIRT 或护理标准。女性将在第 6 个月完成退出研究访谈。 目标 (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介导和 暴力特征中等关联； (2) 基于以下特征描述 WLWH 的潜在子群： 每日 ARV 依从性的近端决定因素，并确定它们与护理保留和病毒感染的关系 镇压。 (3) 与 ARV 护理标准相比，测试 IPV 健康干预措施的效果 坚持、坚持护理和病毒抑制。意义：研究结果将为以下领域的发展提供信息 未来与社区合作伙伴及其患者和集群合作进行个人层面的干预 对艾滋病毒诊所进行的随机试验，以评估诊所一级干预措施的更广泛功效。 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。该项目利用研究团队的优势来解决 IPV- 健康联系并改善妇女的生活。

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.