Building mobile HIV prevention and mental health support in low-resource settings

在资源匮乏的地区建立流动艾滋病毒预防和心理健康支持

• 批准号: 10332885
• 负责人: Corina Lelutiu-Weinberger
• 金额: $ 10万
• 依托单位: RBHS-SCHOOL OF NURSING
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-05 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10332885
• 关键词: AIDS prevention; Address; Alcohol abuse; Alcohols; Behavioral; Bisexual; Caring; Cellular Phone; Cognitive; Collaborations; Communicable Diseases; Communities; Complex; Counseling; Country; Data; Development; Eastern Europe; Ensure; Epidemic; European; Face; Funding; Future; Gays; Gender; Geography; HIV; HIV risk; Health; Health Personnel; Healthcare; Healthcare Systems; Homelessness; Human immunodeficiency virus test; Imprisonment; Individual; Infrastructure; Intervention; Intervention Studies; Interview; Knowledge; Lesbian Gay Bisexual Transgender Queer; Manuals; Mental Depression; Mental Health; Minority; Motivation; National Institute of Mental Health; Needs Assessment; Nongovernmental Organizations; Outcome; Participant; Patients; Personal Satisfaction; Persons; Population; Privacy; Process; Protocols documentation; Psyche structure; Randomized Controlled Trials; Reporting; Research; Research Support; Resources; Rights; Risk; Romania; Secure; Self Efficacy; Self-Injurious Behavior; Sexual Health; Stigmatization; Stress; Stress and Coping; Structure; Substance abuse problem; Tablets; Techniques; Testing; Text; Translating; Treatment Efficacy; Unemployment; United States National Institutes of Health; Violence; Work; acceptability and feasibility; anxiety symptoms; arm; base; behavioral health; comorbidity; condoms; depressive symptoms; efficacy testing; evidence base; experience; follow-up; gender minority; handheld mobile device; health care availability; improved; laptop; mHealth; men; motivational enhancement therapy; programs; response; sex; skills; skills training; social stigma; stressor; theories; transgender

Project Summary Transgender and gender diverse (e.g., gender non-binary) (TGD) individuals remain a hidden group in the Central Eastern European (CEE) country of Romania, with few protections, few equal rights, and many unmet needs. Emerging research with TGD persons in the region indicates that TGD Romanians report particularly high rates of HIV, depression, and hazardous alcohol use, primarily driven by the country’s high structural stigma. Romania’s healthcare system has little expertise for addressing these syndemic health threats. No targeted needs assessments or interventions exist to date in order to remedy these adversities and promote the wellbeing of TGD in Romania, or anywhere in CEE – the region with the fastest-growing HIV epidemic in the world. In response, we propose to create and pilot-test the first intervention in CEE to address the sexual, mental, and behavioral health of TGD people. In 2014, with input from the Romanian LGBTQ community, we created the Comunică [Communicate] intervention, which successfully helped reduce gay and bisexual men’s HIV risk and hazardous alcohol use and improve their mental health. The intervention’s theory and techniques are based on motivational interviewing and cognitive behavioral skills training as adapted for minority stress. Live counseling sessions are delivered by text on a secure platform accessed on any mobile device, which is responsive to participants’ high need for mobility and concealment. In this supplement, we propose to now adapt and pilot-test Comunică to address the shared and unique minority stress determinants facing TGD Romanians to reduce HIV risk, depression, and hazardous alcohol use. Our adaptation will be guided by the gender minority stress framework that acknowledges unique TGD stressors, whose impact our intervention intends to modify. In Aim 1 (mos 1-5), we will identify the unique health needs of Romanian TGD individuals and modify the Comunică intervention to address them. We will interview 20 Romanian TGD individuals who report HIV risk, depression, and hazardous alcohol use, and 10 TGD-affirmative health providers to identify TGD-specific health needs and suggested adaptations to Comunică. In Aim 2 (mo 6), we will iteratively modify the Comunică intervention content to address gender minority stress and other TGD-specific determinants of HIV risk, mental health, and hazardous alcohol use. Finally, in Aim 3 (mos 7-12), we will evaluate the new intervention’s feasibility and acceptability in a one-arm trial with 20 TGD Romanians who report HIV risk, depression, and hazardous alcohol use. Data will be collected at baseline and 3-month follow-up. This project builds on our strong NIH-supported research program focused on the health of LGBTQ people in Romania, in order to create the first intervention to address the sexual, mental, and behavioral health of TGD Romanians. By extending our intervention research to at-risk TGD populations, we will ensure more equitable access to our interventions and embed them within a national infrastructure increasingly eager for and capable of reaching the full diversity of the Romanian LGBTQ population to address its currently unmet needs.

项目摘要 变性人和性别多样(例如，性别非二元)(TGD)个人仍然是一个隐藏的群体 罗马尼亚的中东欧(CEE)国家，几乎没有保护，几乎没有平等的权利，许多人得不到满足 需要。对该地区TGD人群的新研究表明，TGD罗马尼亚人报告说 艾滋病毒、抑郁症和危险饮酒的高比率，主要是由国家的高结构推动的 耻辱。罗马尼亚的医疗系统几乎没有应对这些共同的健康威胁的专业知识。不是 到目前为止，存在有针对性的需求评估或干预措施，以补救这些不利因素并促进 TGD在罗马尼亚或中东欧任何地方的福祉-该地区是#年艾滋病毒流行增长最快的地区 整个世界。作为回应，我们建议在中东欧建立并试行第一个干预措施，以解决性行为、 TGD人群的心理和行为健康状况。2014年，在罗马尼亚LGBTQ社区的投入下，我们 创建了滑稽的ă[交流]干预，成功地帮助减少了同性恋和双性恋男性的 艾滋病毒风险和危险饮酒，并改善他们的心理健康。干预的理论和技术 是基于激励性面谈和认知行为技能培训，以适应少数族裔的压力。 实时咨询会议在任何移动设备上访问的安全平台上以文本形式提供，即 回应参与者对机动性和隐蔽性的高度需求。在本副刊中，我们建议现在 调整和中试Comunică，以解决TGD面临的共同和独特的少数人压力决定因素 罗马尼亚人减少艾滋病毒风险、抑郁症和危险饮酒。我们的适应将以 性别少数群体压力框架，承认独特的TGD压力源，影响我们的干预 打算修改。在目标1(MOS 1-5)中，我们将确定罗马尼亚TGD个人的独特健康需求 并修改Comunică干预以解决这些问题。我们将采访20名罗马尼亚TGD个人，他们 报告艾滋病毒风险、抑郁和危险饮酒，以及10个TGD阳性的健康提供者以确定 TGD型特定的健康需求，并建议适应Comunică。在目标2(Mo6)中，我们将反复修改 Comunică干预内容，以解决性别少数群体压力和其他TGD型特定决定因素 艾滋病毒风险、精神健康和危险饮酒。最后，在目标3(摩西书7-12)中，我们将评估新的 在一项对20名报告艾滋病毒风险的TGD罗马尼亚人进行的单臂试验中，干预的可行性和可接受性， 抑郁症和危险饮酒。数据将在基线和3个月的随访中收集。这个项目 建立在我们强大的NIH支持的研究项目的基础上，该项目专注于罗马尼亚LGBTQ人群的健康 以创建第一个干预措施，以解决TGD罗马尼亚人的性、心理和行为健康问题。 通过将我们的干预研究扩展到TGD高危人群，我们将确保更公平地获得我们的 干预措施，并将其嵌入日益渴望和能够达到的国家基础设施中 罗马尼亚男女同性恋、双性恋和变性者群体的充分多样性，以满足其目前未得到满足的需求。