Developing an intervention to promote API women's sexual and mental health

描述（由申请人提供）：我们的R34目标是系统地修改现有的循证干预措施，“寻求安全”（SS），通过整合针对性别的艾滋病毒干预措施（项目FIO）和亚太岛民的关键文化成分 (API)报告有暴力创伤经历史或诊断为创伤后应激障碍（PTSD）的妇女。这一建议意义重大，因为它旨在减少API妇女的两个公共卫生问题：1）艾滋病毒/性传播感染发病率迅速上升，2）在所有种族妇女群体中，15至24岁之间的自杀率最高。一项基于K 01的初步研究发现，API女性一生中的性创伤和身体创伤与健康风险行为之间存在密切联系。具体来说，那些经历过创伤的人有自杀倾向，物质使用和艾滋病毒风险行为的风险增加。到目前为止，没有具体的干预措施，整合性和心理健康的促进已被测试的API人口，尽管它是在美国增长最快的。对于经历过创伤的妇女，最常用的、由医疗机构支持的干预措施是SS。1然而，干预措施应在文化上适当，并立足于受创伤影响的API妇女的“真实的世界”。因此，我们将制定新的协议，其中包括SS、FIO项目（未来是我们的）、API妇女的独特经验和声音，以及干预专家和API社区咨询委员会的反馈（目标1）。我们建议使用双臂设计（干预组36人，等待列表对照组36人）（目的2）来测试先导性随机临床试验（RCT）的可行性和安全性。我们将启动AWARE（亚洲妇女恢复力和赋权行动），在大波士顿地区筛选至少400名妇女，共招募72名符合PTSD和创伤史标准的妇女。为期10周的干预将给予团体心理治疗沿着安全的每日移动的短信（“AWARE Stories”）。将对团体心理治疗的依从性、安全移动的信息的利用/满意度和安全性（自杀和亲密伴侣暴力）进行可行性结局测试。我们还旨在测试AWARE的有效性（目标3）。我们将在基线、第10周和第3个月测量HIV相关结局（主要结局）以及精神症状和物质使用（次要结局），以确定适应性干预结局的效应量。这种综合的、整体的方法在多个方面都是创新的：（1）该研究将是第一个针对创伤API妇女的试点RCT研究，（2）它结合了一种文化上适当的干预措施，可以广泛获得、接受和可行，（3）它旨在减少艾滋病毒风险行为，（4）它测试了移动技术的可行性。拟议的研究项目响应了NIH、NIMH和Healthy People 2010的多个优先事项。将来，这些发现可以转化为更大的RCT。是我们的宗旨 这些努力将最终导致减少艾滋病毒传播、自杀和API妇女的精神症状。

DESCRIPTION (provided by applicant): Our objective for this R34 is to systematically modify the existing evidence-based intervention, "Seeking Safety" (SS), by integrating a gender-specific HIV intervention (Project FIO) and critical cultural components for Asian-Pacific Islander (API) women who report a history of violent traumatic experience or a diagnosis of Post-Traumatic Stress Disorder (PTSD). This proposal is significant because it aims to reduce two public health problems among API women: 1) the rapidly rising incidence of HIV/STIs, and 2) the highest rates of completed suicide between the ages 15 to 24 among all racial groups of women. A preliminary study based on a K01 identified a strong association between lifetime sexual and physical trauma and health risk behaviors in API women. Specifically, those who experienced trauma had elevated risks of suicidality, substance use, and HIV risk behaviors. To date, no specific intervention that integrates sexual and mental health promotion has been tested for the APIs population, despite it is the fastest growing in the US. The most commonly applied, empirically-supported intervention for women who have experienced trauma is SS.1 However, the intervention should be culturally appropriate and grounded in "the real world" of API women affected by trauma. Thus, we will develop new protocols, which incorporate SS, Project FIO (Future is Ours), API women's unique experiences and voices, and feedback from intervention experts and an API Community Advisory Board (CAB) (Aim 1). We propose to test the feasibility and safety of a pilot randomized clinical trial (RCT) using a two- armed design (with an intervention group of 36, and a wait-list control group of 36) (Aim 2). We will launch AWARE (Asian Women's Action for Resilience and Empowerment) to screen at least 400 women in the greater Boston area and recruit a total of 72 women who meet the criteria for PTSD and traumatic history. The 10-week intervention will be given group psychotherapy along with secure daily mobile text messages ("AWARE Stories"). Adherence to group psychotherapy, utilization/satisfaction of secure mobile messages, and safety (suicidality and intimate partner violence) will be tested as feasibility outcomes. We also aim to test the efficacy of AWARE (Aim 3). We will measure HIV-related outcomes (primary outcomes) and psychiatric symptoms and substance use (secondary outcomes) at baseline, week 10, and 3 months to determine effect sizes for outcomes of the adapted intervention. This integrative, holistic approach is innovative in multiple ways: (1) the study will be the first pilot RCT study to target traumatized API women, (2) it incorporates a culturally appropriate intervention to be widely available, acceptable, and feasible, (3) it is designed to reduce HIV risk behavior, and (4) it tests the feasibility of a moble technology. The proposed research project responds to multiple priorities of NIH, NIMH, and Healthy People 2010. In the future, the findings can be translated into a larger RCT. It is our aim that these efforts will ultimately lead to the reduction of HIV transmission, suicidality, and psychiatric symptoms among API women.