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

识别日间可改变的风险和保护流程，预测遭受伴侣暴力的妇女的艾滋病毒护理结果

• 批准号: 10308056
• 负责人: Jaimie Meyer
• 金额: $ 60.86万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-01-01 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10308056
• 关键词: Address; Adherence; Adult; Affect; Anti-Retroviral Agents; Anxiety; Attention; Awareness; Caring; Characteristics; Chronic; Chronic Disease; Clinic; Cluster randomized trial; Collaborations; Communities; Connecticut; Continuity of Patient Care; Cross-Sectional Studies; Data; Data Collection; Detection; Development; Disease; Enrollment; Exposure to; Face; Follow-Up Studies; Frequencies; Funding; Future; HIV; HIV risk; Health; Individual; Intervention; Interview; Mediating; Mental Depression; Mental Health; Meta-Analysis; Methods; Outcome; Patients; Pattern; Pharmaceutical Preparations; Process; Protocols documentation; Provider; Psychiatric therapeutic procedure; Public Health; Randomized; Research; Resources; Risk; Risk Reduction; Self Efficacy; Self Management; Social support; Specialist; Subgroup; Substance Use Disorder; Target Populations; Testing; Time; Training; Treatment outcome; Violence; Viral; Woman; base; care outcomes; community organizations; community violence; comorbidity; emotion regulation; experience; high risk population; improved; inattention; intimate partner violence; longitudinal design; mHealth; medication compliance; member; modifiable risk; negative affect; outreach; partner violence; protective effect; protective factors; psychologic; recruit; resilience; scale up; screening and brief intervention; screening, brief intervention, referral, and treatment; standard of care; substance use; tool; trauma symptom; treatment as usual; violence exposure; violence victimization

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.

项目总结