Striving Towards Empowerment and Medication Adherence (STEP-AD)

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 DESCRIPTION (provided by applicant): In the U.S. Black women represent 63% of all new HIV diagnoses among women1 and estimates of adherence to ART among racial/ethnic minority women are between 45% and 64%,6 below the recommended levels. Inadequate rates of ART are likely due to relevant psychosocial and contextual factors facing Black women with HIV such as abuse/trauma histories, posttraumatic stress, racial discrimination, HIV- related stigma/discrimination, and prescribed female traditional gender roles; each of which are associated with worse HIV outcomes.7-11 There is currently no evidenced-based psychosocial intervention for Black women with HIV that addresses these contextual factors to improve ART adherence. CANDIDATE: I am an African- American Psychology Fellow at Massachusetts General Hospital/Harvard Medical School with 14 peer- reviewed publications and chapters (7 first-authored) on psychosocial factors (e.g. trauma, discrimination, gender roles) and health outcomes (e.g. ART adherence) among women and racial/ethnic minorities with HIV. The present proposal will allow me to acquire needed skills to become an independent researcher developing prevention and intervention strategies to promote positive health outcomes amongst racial/ethnic minorities with or at risk for HIV. MENTORING: Dr. Steven Safren, the primary mentor, has expertise in addressing psychosocial problems in the context of interventions for self-care in HIV (e.g. ART adherence). Drs. Laura Bogart and Conall O'Cleirigh are co-mentors and add respective expertise in discrimination among African Americans with HIV and integrating trauma strategies in HIV interventions. RESEARCH: The purpose of the current study is to develop and assess the feasibility and acceptability of an intervention to improve medication adherence for Black women with HIV by combining evidence-based strategies for trauma symptom reduction, strategies for coping with racial and HIV-related discrimination, gender empowerment, problem solving techniques for medication adherence, and resilient coping. Specific research aims are: (1) To develop an intervention and conduct an open pilot trial (N=10) of the intervention to initially assess feasibility of all study procedures and intervention delivery, acceptability, and a potential clinically significant improvement on ART adherence and hypothesized psychosocial mediators, (2) Conduct a pilot randomized control trial (RCT) comparing the newly developed treatment (N=25) to an enhanced treatment as usual control (N=25) on ART adherence (primary outcome) and viral load (secondary outcome) over 6 months, and (3) Prepare for conducting an adequately powered RCT in a community clinic through engagement (e.g. qualitative interviews, demonstration of intervention) with community members and potential deliverers of the intervention (e.g. case managers). TRAINING: Via coursework, seminars, and mentorship I will fulfill three training goals: (1) Enhance skills for developing HIV interventions for racial/ethnic minorities, (2) Acquire skills in community engagement and implementation research, and (3) Develop competence in advanced longitudinal statistics.