Improving HIV Care Engagement Among Ugandan Adolescent Girls and Young Women Through Reductions in Male Partner Alcohol Use and Intimate Partner Violence Risk: The Kisoboka Mukwano Intervention

通过减少男性伴侣饮酒和亲密伴侣暴力风险，提高乌干达少女和年轻女性的艾滋病毒护理参与度：Kisoboka Mukwano 干预措施

• 批准号: 10542322
• 负责人: Susan Maria Kiene
• 金额: $ 24.21万
• 依托单位: ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-20 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542322
• 关键词: Address; Affect; Africa South of the Sahara; Alcohol consumption; Alcohols; Behavior; Behavioral; Caring; Clinical Trials; Collaborations; Conflict (Psychology); Control Groups; Counseling; Country; Couples; Development; Disease; Emotional; Ever Married; Female; Female Adolescents; Future; Gender; Glare; HIV; HIV Seronegativity; HIV diagnosis; Heavy Drinking; Heterosexuals; Intervention; Love; Marriage; Men' s Role; Mental Depression; Outcome; Pharmaceutical Preparations; Physical aggression; Population; Process; Qualitative Research; Randomized; Recording of previous events; Reporting; Research; Research Personnel; Risk; Safety; Spouses; Stress; Testing; Time; Treatment outcome; Uganda; Unsafe Sex; Viral; Viral Load result; Woman; aged; alcohol intervention; antiretroviral therapy; arm; base; binge drinking; coping; emotional abuse; experience; follow-up; health care availability; improved; improved outcome; informant; intervention effect; intimate partner violence; male; medication compliance; men; motivational enhancement therapy; peer; pill; pilot test; prevent; relationship abuse; sexual coercion; therapy adherence; transmission process; treatment as prevention; violence victimization; young woman

PROJECT SUMMARY / ABSTRACT In Uganda, adolescent girls and young women (AGYW) are disproportionately affected by HIV and have poor viral suppression rates, increasing their risk of onward transmission. Intimate partner violence (IPV) is a major barrier to mitigating the impact of HIV among AGYW. AGYW living with HIV (AGYWLHIV) in sub- Saharan Africa (SSA) who have experienced IPV have worse medication adherence, viral suppression, and care engagement than those without IPV. Further, male partner alcohol use directly and indirectly increases IPV risk among AGYW in SSA. Thus, an intervention with components that address heavy alcohol use among male partners could decrease AGYW’s IPV risk, especially in Uganda, which has the highest alcohol use per capita in SSA. Couples- based interventions have effectively reduced male partner alcohol use, relationship conflict IPV, and improved viral suppression and HIV care engagement; yet, none have been tailored to AGYWLHIV in SSA. We propose to develop and pilot a couples-based intervention that focuses on improving HIV care engagement and ART adherence among AGYWLHIV by reducing heavy alcohol use among male partners and couple IPV risk. Additionally, we will explore the intervention’s effects on AGYW viral load for the additional key benefit of treatment as prevention. Our aims are to: 1) Adapt the behavioral components of a brief MI-based alcohol intervention to create the proposed Kisoboka Mukwano (“It is possible, my love!”) intervention. The intervention will promote strategies for reductions in male partner alcohol use, coping with relationship conflict and stress, changing norms that reduce IPV and support engagement in HIV care and ART adherence among AGYWLHIV, and, thereby, enhance future sustained viral suppression and benefits of treatment as prevention. The intervention will be adapted and tailored to be delivered with heterosexual couples, involve peer navigators, address IPV, and be developmentally appropriate for AGYWLHIV in Uganda. We will develop and refine the intervention in collaboration with an intervention steering committee through: qualitative research with married/cohabiting AGYWLHIV, married/cohabiting men, and key informants and an initial pilot test with 6 couples. 2) We will assess safety, acceptability, feasibility, and preliminary estimates of the potential for the intervention, as compared to the control group, to improve HIV, alcohol, and IPV outcomes. We will examine preliminary effects on AGYW HIV care engagement, AGYW ART adherence, heavy alcohol use among male partners, and couple IPV risk and explore effects on AGYW viral load as well as intermediate outcomes related to intervention components. We will assess these outcomes at baseline and then at 3- and 6-month follow-up. Study findings will be used to guide a subsequent R01 proposal to test the intervention in a larger clinical trial.

项目摘要 /摘要 在乌干达，青少年女孩和年轻女性（AGYW）受艾滋病毒的影响不成比例，并且 病毒抑制率差，增加了其继续传播的风险。亲密的伴侣暴力（IPV）是 减轻艾滋病毒在AGYW中的影响的主要障碍。 Agyw与艾滋病毒（Agywlhiv）一起生活 经历过IPV的撒哈拉非洲（SSA）的药物依从性，病毒抑制和 与没有IPV的人相比。此外，男性伴侣的饮酒直接和间接增加 SSA中AGYW的IPV风险。这是针对解决大量饮酒的组件的干预措施 在男性合作伙伴中，可能会降低AGYW的IPV风险，尤其是在乌干达，它的酒精最高 在SSA中使用人均。基于夫妻的干预措施有效地减少了男性伴侣的饮酒， 关系冲突IPV，改善了病毒抑制和HIV护理参与；但是，没有 针对SSA的Agywlhiv量身定制。我们建议开发和试行基于夫妻的干预措施，以重点 通过减少大量酒精的使用来改善AGYWLHIV中的艾滋病毒护理参与和艺术依从性 在男性合作伙伴和夫妇IPV风险中。此外，我们将探讨干预对AGYW的影响 病毒载荷是预防治疗的额外关键好处。我们的目标是：1）适应行为 简短基于MI的酒精干预的组件，以创建拟议的Kisoboka Mukwano（“是 可能，我的爱！”）干预。干预将促进男性伴侣减少的策略 饮酒，应对关系冲突和压力，改变了减少IPV和支持的规范 参与Agywlhiv之间的艾滋病毒护理和艺术依从性，从而增强了未来的持续 病毒抑制和治疗的益处。干预措施将被调整并量身定制为 与异性恋夫妇交付，涉及同行导航器，地址IPV，并进行开发 适合乌干达的Agywlhiv。我们将与 干预指导委员会通过：与已婚/同居Agywlhiv的定性研究， 已婚/同居的男人和主要线人以及与6对夫妇的初步试点测试。 2）我们将评估安全性， 相比之下 对照组，以改善艾滋病毒，酒精和IPV结果。我们将检查对AGYW的初步影响 HIV护理参与，AGYW艺术依从性，男性伴侣中的大量酒精以及夫妇IPV 风险和探索对AGYW病毒负荷以及与干预相关的中间结果的影响 成分。我们将在基线和3个月的随访中评估这些结果。学习 调查结果将用于指导随后的R01提案，以测试大型临床试验中的干预措施。