Effects of Partner Violence and Mental Health on HIV Disease Progression in Women

描述(由申请人提供)：拟议的混合方法研究旨在研究亲密伴侣暴力(IPV)与生殖胁迫、心理健康和艾滋病毒治疗坚持以及疾病进展之间的复杂关系。包括药物滥用、抑郁和创伤后应激障碍在内的途径将被研究。女性将从一家城市艾滋病毒诊所招募，该诊所主要服务于低收入的非裔美国人。非裔美国妇女受到艾滋病毒、暴力和药物滥用相互交织的流行病的不成比例的影响。研究的第一阶段将包括从符合条件的妇女那里收集的关于过去一年、IPV、生殖强迫、创伤后应激障碍症状、抑郁症状、药物滥用和艾滋病毒药物依从性的定量数据。将审查参与者的医疗记录，以获得疾病进展和服药依从性的生物标记(CD4计数和病毒载量)，以及与艾滋病毒疾病进展(住院、机会性感染)和精神健康相关诊断(创伤后应激障碍、抑郁、药物滥用)相关的协变量。在审查IPV和生殖胁迫对艾滋病毒疾病进展和治疗依从性(CD4计数、病毒载量和错过就诊)的直接和中介影响之前，将估计IPV和生殖胁迫的流行率。在分析了第一阶段的数据之后，将有目的地选择一批妇女进行第二阶段的定性访谈。这些定性访谈的目的是探索妇女对IPV和生殖胁迫的看法，以及在坚持和疾病进展中的作用。这项拟议研究的结果将被用来提供有文化能力的干预措施，以减少城市艾滋病毒阳性妇女的健康差距。

DESCRIPTION (provided by applicant): The proposed mixed-methods study aims to examine the complex relationship between intimate partner violence (IPV) and reproductive coercion, mental health and HIV treatment adherence and disease progression. Pathways including substance abuse, depression and post-traumatic stress disorder will be examined. Women will be recruited from an urban HIV clinic that serves a primarily low income, African American population. African American women are disproportionally affected by the intertwined epidemics of HIV, violence and substance abuse. Phase 1 of the study will include quantitative data regarding past year, IPV, reproductive coercion, PTSD symptoms, depressive symptoms, substance abuse, and HIV medication adherence collected from eligible women. Participant's medical records will be reviewed to obtain biologic markers of disease progression and medication adherence (CD4 count and viral load) as well as covariates related to HIV disease progression (hospitalizations, opportunistic infections) and verification of mental health related diagnoses (PTSD, depression, substance abuse). Prevalence of IPV and reproductive coercion will be estimated, prior to examining the direct and mediated effects of IPV and reproductive coercion on HIV disease progression and treatment adherence (CD4 counts, viral load and missed clinic visits). Following analysis of Phase 1 data, a subsample of women will be purposefully selected for Phase 2 qualitative interviews. The aim of these qualitative interviews is to explore women's perceptions on IPV and reproductive coercion and the role in adherence and disease progression. The findings from the proposed study will be used to inform culturally competent interventions to reduce health disparities among urban, HIV positive women.