Prevalence of DSM-IV Disorders in an Multi-Center HIV+ Women's Cohort

描述(申请人提供)：由NIAID、NIDA、NCI和NICHD资助的女性机构间艾滋病毒研究(WIHS)是一项关于美国6个地点(包括布鲁克林、布朗克斯、芝加哥、洛杉矶、旧金山/湾区和华盛顿特区)的1,508名艾滋病毒阳性女性的艾滋病毒疾病进展的多地点队列研究。自1994年以来，妇女参加了每两年一次的研究访问，其中包括体检和妇科检查、血清学和唾液样本，以及实施一系列关于健康、心理社会状况、服务利用和人口特征的广泛措施。这一群体主要是非洲裔美国人(72%)和拉丁裔(27%)；一半生活在贫困中(52%)；三分之二没有工作(66%)；相当一部分人没有完成高中学业(40%)；女性平均年龄为45岁。到目前为止，WIHS对精神健康和物质使用的评估仅限于自我报告的抑郁和焦虑症状，以及自我报告的酒精和街头药物使用。这项研究的目的是向WIHS队列实施行为健康流行病学结构化诊断访谈的黄金标准--世界精神卫生-综合国际诊断访谈(WMH-CIDI)。第一项研究的目的是确定队列中精神健康和物质使用障碍(MH/SUD)的患病率、类型和严重程度。第二个目标是进行分析，解决两种特定的MH/SUD--抑郁症和强效可卡因滥用/依赖--与疾病进展和免疫重建的免疫和病毒学成分、艾滋病定义的疾病、死亡率以及HAART的使用和依从性之间的关系。这将包括在2010年和2011年分别在WIHS的6个地点向WIHS队列成员管理WMH-CIDI，并将他们的诊断数据与WIHS核心数据联系起来。这些核心数据将提供6个月和12个月的结果，评估疾病进展(例如，HIV1-RNA、CD4、定义艾滋病的疾病)和与艾滋病相关的死亡率。WMH-CIDI将由WIHS面试者在单独的研究访问中进行管理，他们已经由世界卫生组织赞助的培训者在笔记本电脑CIDI管理方面进行了培训和认证。研究对象将接受单独的同意程序，并将获得研究酬金和旅行津贴。鉴于我们对HIV+人群中HIV和MH/SU疾病共同发病的了解不足，这项研究有可能增强我们对行为健康因素如何影响康复和长期生存的知识。WMH-CIDI数据也将提供给更大WIHS的研究人员，使他们能够检查MH/SUD在他们正在进行的神经认知、基因组、病毒学和免疫学研究中的影响。 公共卫生相关性：在艾滋病毒阳性的成年人中，艾滋病毒疾病与精神和药物使用障碍并存的比率很高，有证据表明，这些障碍干扰了有效抗逆转录病毒疗法的启动和继续使用。先前的研究还表明，某些精神健康障碍，如抑郁症，在艾滋病毒+女性中的发生率高于男性，而成瘾障碍，如强效可卡因滥用/依赖，对妇女艾滋病毒疾病的进展和死亡率具有特别有害的影响。这项研究的重点是精神疾病和成瘾如何影响艾滋病毒的治疗、疾病进展和死亡率，这一研究有可能产生极大地提高我国公共健康的知识。

DESCRIPTION (provided by applicant): Funded by NIAID, NIDA, NCI, and NICHD, the Women's Interagency HIV Study (WIHS) is a multi-site cohort study of HIV disease progression in 1,508 HIV-positive women at 6 sites in the U.S. including Brooklyn, Bronx, Chicago, Los Angeles, San Francisco/Bay Area, and Washington, DC. Since 1994, women have participated in bi-annual study visits that include physical and gynecological exams, serologic and salivary samples, and administration of an extensive battery of measures regarding health, psychosocial status, service utilization, and demographic features. The cohort is primarily African American (72%) and Latina (27%); half live in poverty (52%); two-thirds are not employed (66%); a substantial proportion did not complete high school (40%); and women average 45 years of age. To date, assessment of mental health and substance use in the WIHS has been limited to self- reported symptoms of depression and anxiety, and self-reported use of alcohol and street drugs. The purpose of this study is to administer to the WIHS cohort the gold standard in structured diagnostic interviews for behavioral health epidemiology, the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI). The first study aim is to determine the prevalence, type, and severity of mental health and substance use disorders (MH/SUD) in the cohort. The second aim is to conduct analyses addressing associations between 2 specific MH/SUDs -- depression and crack cocaine abuse/dependence - and immunological and virological components of disease progression and immune reconstitution, AIDS-defining illnesses, mortality, and HAART use and adherence. This will involve administering the WMH-CIDI to members of the WIHS cohort at each of its 6 sites in 2010 and 2011, and linking their diagnostic data to WIHS core data. These core data will provide 6-month and 12-month outcomes assessing disease progression (e.g., HIV1-RNA, CD4, AIDS-defining illnesses) and AIDS-related mortality. The WMH-CIDI will be administered at a separate study visit by WIHS interviewers who have been trained and certified in laptop CIDI administration by World Health Organization-sponsored trainers. Study subjects will undergo a separate consent process, and will receive a research honorarium along with travel stipends. Given the paucity of our knowledge about co-morbidity of HIV and MH/SU disorders in large cohorts of HIV+ individuals, this study has the potential to enhance our knowledge about how behavioral health factors impact recovery and long- term survival. WMH-CIDI data will also be made available to investigators in the larger WIHS, enabling them to examine the impact of MH/SUD in their ongoing neurocognitive, genomic, virologic, and immunologic studies. PUBLIC HEALTH RELEVANCE: Rates of co-occurrence of HIV disease with psychiatric and substance use disorders are high among HIV-positive adults, and evidence suggests that these disorders interfere with the initiation and continued use of effective antiretroviral therapies. Prior research also shows that certain mental health disorders, such as depression, occur at higher rates in HIV+ women than men, and that addictive disorders, such as crack cocaine abuse/dependence, have a particularly deleterious effect on women's HIV disease progression and mortality. This study's focus on how mental illness and addiction impact treatment for HIV, disease progression, and mortality has the potential to produce knowledge that will greatly enhance our nation's public health.