Testing the effectiveness of an evidence-based transdiagnostic cognitive behavioral therapy approach for improving HIV treatment outcomes among violence-affected and virally unsuppressed women in SA

项目摘要 目前，南非有不到100万艾滋病毒携带者已经开始抗逆转录病毒治疗。 治疗(ART)，但保持不受抑制。南非在实现联合国艾滋病规划署的目标方面取得了进展 目标，但只达到47%的感染者被病毒抑制。因此，如果有效的方法 如果能发现能使患者继续接受治疗、坚持和病毒抑制，其影响可能是显著的。 在南非，持续治疗的一个主要障碍是亲密伴侣暴力(IPV)，因为近50%的 女性经历过IPV。解决IPV问题可能会对支持艾滋病毒治疗的患者产生影响 继续坚持。共同元素治疗方法(CETA)是一种循证干预 由认知-行为治疗元素组成。它是跨诊断的，因为它可以灵活地解决范围 并代表了全球心理健康的当前趋势，作为一种更具成本效益、更具可扩展性的 和可持续发展的模式。CETA是最有希望通过以下途径影响艾滋病毒结果的干预措施之一 解决暴力问题 为了评估CETA，我们建议对感染艾滋病毒的妇女进行一项随机对照试验，包括是否有 他们的伴侣经历过IPV，并有未受抑制的病毒载量，以测试CETA对 加强对病毒的抑制，减少暴力。这项研究有三个目标：目标1：在感染艾滋病毒的人群中 接受抗逆转录病毒治疗的女性经历过IPV并有未被抑制的病毒载量，以评估其有效性 CETA与主动控制相比，保留和病毒抑制的比例增加了12个月， 降低IPV和其他精神和行为健康问题的严重程度 随机试验。目标2：确定CETA对主要结果影响的调解人和调节者 (滞留和病毒抑制)。目标3：评估CETA与主动控制的成本和成本效益 在增加经历过IPV的妇女被保留并被病毒抑制的比例 12个月。 考虑到IPV在未被抑制的女性患者中的患病率，这项研究问题意义重大 南非的病毒载量以及通过解决IPV及其后遗症改善病毒抑制的潜力。 如果有效，这种方法可能会对病毒未被抑制的结果产生重大的全球影响 并减少对未受感染的伴侣的传播。它在利用以证据为基础的 被证明影响IPV的方法(CETA)以及导致艾滋病毒治疗不力的许多其他问题 结果。

Project Summary There are currently just under one million people with HIV in South Africa who have initiated antiretroviral therapy (ART) but remain unsuppressed. South Africa has been making progress towards UNAIDS 90-90-90 targets but has only reached 47% of those infected being virally suppressed. Therefore, if effective approaches can be found to keep patients on treatment, adhering, and virally suppressed, the impact could be significant. In South Africa, one major barrier to consistent treatment is intimate partner violence (IPV) as nearly 50% of women have experienced IPV. Addressing IPV could have effects in supporting patients on HIV treatment to continue to adhere. The Common Elements Treatment Approach (CETA) is an evidence-based intervention comprised of cognitive-behavioral therapy elements. It is transdiagnostic in that it can flexibly address a range of problems and represents the current movement in global mental health as a more cost effective, scalable and sustainable model. CETA is one of the most promising interventions to impact HIV outcomes through addressing violence To evaluate CETA, we propose a randomized controlled trial of HIV-infected women, with or without their partners, who have experienced IPV and have an unsuppressed viral load to test the effect of CETA on increasing viral suppression and reducing violence. The study has three aims: Aim 1: Among HIV-infected women on ART who have experienced IPV and have an unsuppressed viral load, to assess the effectiveness of CETA vs. active control at increasing the proportion retained and virally suppressed by 12 months and at decreasing the severity of IPV and other mental and behavioral health problems using an individually randomized trial. Aim 2: To identify mediators and moderators of CETA’s effect on the primary outcome (retention and viral suppression). Aim 3: To assess the cost and cost-effectiveness of CETA vs. active control at increasing the proportion of women who have experienced IPV who are retained and virally suppressed by 12 months. The study question is significant given the prevalence of IPV in female patients with unsuppressed viral loads in South Africa and the potential for improving viral suppression by addressing IPV and its sequelae. If effective, this approach could have a significant global impact on outcomes for virally unsuppressed women and reduce transmission to uninfected partners. It is innovative in utilizing an evidence-based approach (CETA) shown to affect IPV as well as many other problems that contribute to poor HIV treatment outcomes.