Gender Based Violence and HIV Outcomes: Tracking and Treating Mental Illness

基于性别的暴力和艾滋病毒结果：跟踪和治疗精神疾病

• 批准号: 8659802
• 负责人: Susan M. Meffert
• 金额: $ 18.18万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-06-09 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8659802
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adherence; Adverse effects; Affect; Africa South of the Sahara; Age; Anxiety Disorders; Award; Awareness; California; Caring; Cause of Death; Chronic Disease; Cognitive Therapy; Cohort Studies; Collaborations; Country; Cross-Sectional Studies; Data; Diagnosis; Dysthymic Disorder; Education; Family; Funding; Gender; Goals; HIV; HIV Infections; Health; Healthcare; Highly Active Antiretroviral Therapy; Income; Individual; Injury; Intervention; Intervention Studies; K-Series Research Career Programs; Kenya; Knowledge; Laboratories; Location; Major Depressive Disorder; Manuals; Mediating; Mediation; Mediator of activation protein; Mental Depression; Mental Health; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mission; Mood Disorders; National Institute of Mental Health; Natural History; Outcome; Participant; Pathway interactions; Pilot Projects; Population; Post-Traumatic Stress Disorders; Province; Psychiatric therapeutic procedure; Psychiatry; Psychotherapy; Public Health; Publishing; Refugees; Reporting; Research; Research Infrastructure; Research Training; Resources; Scientist; Services; Structure; Testing; Time; Training; Trauma; Trauma Research; Treatment Efficacy; Uganda; Victimization; Violence; Viral Load result; Waiting Lists; Woman; Work; base; burden of illness; career; cohort; disability; efficacy testing; experience; improved; longitudinal analysis; minor depressive disorder; novel; physical conditioning; professor; programs; prospective; public health relevance; reproductive; skills

DESCRIPTION (provided by applicant): This is a re-submission of a K23 award for Susan Meffert MD, MPH, Assistant Professor of Psychiatry at UCSF. This career award proposal builds on Dr. Meffert's research with emotionally traumatized populations in Low-and-Middle-Income Countries (LMICs) and proposes research and training goals to focus her work on HIV-infected (HIV+) women exposed to Gender-Based Violence (GBV) (HIV+GBV+). Despite knowledge that GBV has profound adverse effects on physical health (exceeding direct injury),1-4 and that GBV is highly prevalent among HIV+ women,5,6 little is known about how GBV affects HIV outcomes. In cross sectional analysis, GBV is associated with detectable viral load (VL) and decreased CD4 count.7 Mental health sequeale of GBV, including Posttraumatic Stress Disorder (PTSD) and depression, are theorized mediators of the relationships between violence, HAART adherence and poor HIV outcomes.7,8 However, without a data-driven understanding of these relationships, we are unable to develop psychiatric treatments that effectively improve the overall health of the extraordinary numbers of HIV+ women exposed to GBV. The proposal addresses this crucial knowledge gap using a large longitudinal cohort study of HIV+ women and a pilot intervention with HIV+GBV+ women in a high burden region. Mentored by internationally recognized scientists, I propose three research aims: Aim 1 is a longitudinal analysis of GBV, HIV outcomes and mental health mediators in the largest prospective cohort study of HIV- affected women (Women's Interagency HIV Study [WIHS]). My co-mentor, Ruth Greenblatt, MD, is the N. California PI for the WIHS study. Building on my work with the UCSF-Family AIDS Care Education and Services (FACES) program in a high HIV region of Kenya, Aim 2 is an adaptation of an established mental health treatment (Interpersonal Psychotherapy [IPT]) for depression and PTSD among HIV+GBV+ women at FACES. Aim 3 is a pilot study assessing feasibility and acceptability of the adapted IPT. UCSF-FACES is a PEPFAR-funded care and research collaboration serving more than 90,000 HIV+ individuals in western Kenya. FACES has robust research infrastructure and I have an established, highly productive research team onsite. This proposal is significant because it will generate the first longitudinal analysis of GBV, HIV outcomes and mental disorders, and the first mental health intervention adapted and piloted for HIV+GBV+ women. These studies may substantially improve women's HIV programs by addressing a largely untapped mental health pathway affecting HIV outcomes among GBV+ women and developing/piloting a psychiatric treatment for HIV+GBV+ women. These research aims are tightly integrated with my training goals: (1) Longitudinal analytic methods in HIV; (2) IPT adaptation and (3) Mental health intervention research. These studies will generate preliminary findings for an R01-funded intervention testing the efficacy of adapted IPT for the effects of GBV on psychiatric and HIV outcomes.

描述（由申请人提供）：这是为加州大学旧金山分校精神病学助理教授、医学博士、公共卫生硕士 Susan Meffert 重新提交的 K23 奖项。这项职业奖提案以 Meffert 博士对中低收入国家 (LMIC) 情感创伤人群的研究为基础，并提出了研究和培训目标，将她的工作重点放在遭受性别暴力 (GBV) (HIV+GBV+) 的艾滋病毒感染者 (HIV+) 女性。尽管人们知道 GBV 对身体健康具有深远的不利影响（超过直接伤害），1-4 并且 GBV 在 HIV + 女性中非常普遍，5,6 但人们对 GBV 如何影响 HIV 结果知之甚少。在横断面分析中，GBV 与可检测到的病毒载量 (VL) 和 CD4 计数减少相关。7 GBV 的心理健康后遗症，包括创伤后应激障碍 (PTSD) 和抑郁症，理论上是暴力、HAART 依从性和不良 HIV 结果之间关系的中介因素。7,8 然而，如果没有对这些关系的数据驱动的理解，我们就无法开发有效改善整体健康的精神治疗方法 大量艾滋病毒阳性女性暴露于性别暴力。该提案利用对 HIV+ 女性的大型纵向队列研究以及对高负担地区 HIV+GBV+ 女性的试点干预来解决这一关键的知识差距。在国际知名科学家的指导下，我提出了三个研究目标： 目标 1 是在最大的受艾滋病毒影响的女性前瞻性队列研究（妇女机构间艾滋病毒研究 [WIHS]）中对 GBV、艾滋病毒结果和心理健康中介因素进行纵向分析。我的合作导师 Ruth Greenblatt 医学博士是北加州 WIHS 研究的 PI。基于我在肯尼亚艾滋病毒高发地区的 UCSF-家庭艾滋病护理教育和服务 (FACES) 项目的工作，目标 2 是对 FACES 中针对 HIV+GBV+ 女性抑郁症和 PTSD 的既定心理健康治疗（人际心理治疗 [IPT]）的改编。目标 3 是一项试点研究，评估改编后的 IPT 的可行性和可接受性。 UCSF-FACES 是一项由 PEPFAR 资助的护理和研究合作项目，为肯尼亚西部超过 90,000 名艾滋病病毒感染者提供服务。 FACES 拥有强大的研究基础设施，我在现场拥有一支成熟、高效的研究团队。该提案意义重大，因为它将产生对 GBV、HIV 结果和精神障碍的首次纵向分析，以及第一个针对 HIV+GBV+ 女性进行调整和试点的心理健康干预措施。这些研究可能通过解决影响 GBV+ 女性 HIV 结果的很大程度上尚未开发的心理健康途径，并为 HIV+GBV+ 女性开发/试点精神病治疗，从而大大改善女性的 HIV 项目。这些研究目标与我的培训目标紧密结合：（1）HIV纵向分析方法； (2)IPT适应和(3)心理健康干预研究。这些研究将为 R01 资助的干预措施提供初步结果，该干预措施将测试改编后的 IPT 对 GBV 对精神疾病和艾滋病毒结果的影响的功效。