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Preventing HIV among Native Americans through the treatment PTSD & substance use

通过治疗创伤后应激障碍 (PTSD) 预防美洲原住民艾滋病毒

基本信息

批准号：
9360567
负责人：
DEBRA L KAYSEN
金额：
$ 64.7万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-09-27 至 2021-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9360567
关键词：
AIDS prevention Address Alaska Native Alcohol dependence Alcohol or Other Drugs use American American Indians Area Assertiveness Behavior Client Clinical Collaborations Communication Communities Coupled Development Diagnosis Disease Drug Addiction Elderly Elements Evidence based intervention Evidence based program Evidence based treatment Face Frequencies Future Generations General Population Goals HIV HIV risk HIV/STD Health Promotion Individual International Intervention Left Mediating Mediator of activation protein Mental Health Meta-Analysis Methods Motivation Native Americans Oral Outcome Pathway interactions Population Population Heterogeneity Post-Traumatic Stress Disorders Prevention Public Health Randomized Relapse Reservations Resources Risk Risk Behaviors Risk Factors Self Efficacy Self Medication Severities Substance Addiction Substance Use Disorder Substance abuse problem Symptoms Tactile Testing Time Trauma Tribes Unsafe Sex Washington Woman Yakama Indian arm base behavioral outcome cognitive reappraisal comparative effectiveness condoms coping disorder prevention disorder risk effectiveness trial emotion regulation follow-up health disparity high risk improved men motivational enhancement therapy pilot trial post intervention prevent programs public health relevance reduced substance use sex sex risk skills skills training substance misuse prevention substance use prevention treatment program trial comparing tribal Nation tribal lands

项目摘要

DESCRIPTION (provided by applicant): Untreated PTSD elevates risk of concurrent alcohol and drug dependence (>50% and >30% respectively), which in turn elevates risk of HIV sexual-risk behavior (HSB). A meta-analysis of HIV prevention, found few interventions address risk factors such as trauma exposure, mental health, or SUD and interventions which failed to do so had poorer condom use outcomes and were less effective for those with PTSD. From a public health perspective addressing PTSD and substance use disorders (SUD) is an important but overlooked means of preventing HIV/STI. American Indian (AI) communities are at disproportionate risk for untreated PTSD, SUD and HIV/STI risk. Self-medication of PTSD through substance use leads to development of SUDs, and exacerbates HSB. Therefore, treatment of PTSD that also decreases substance use in individuals may prevent the initiation or relapse of HIV risk behaviors. Similarly, directly intervening to reduce substance use via increasing motivation to decrease use and enhance coping strategies should prevent SUD development, and improve HSB and PTSD. Thus addressing PTSD or substance use may effectively prevent HSB. Built on an 8-year community-based participatory partnership, in full collaboration with the Tribal Nation, this study proposes a 5-year two-arm randomized comparative effectiveness trial to evaluate prevention of HIV/STI sexual risk behavior by directly addressing PTSD or substance use. We will evaluate Narrative Exposure Therapy (NET) versus Motivational Interviewing with Skills Training (MIST) in HIV/STI prevention. AI elder and community leaders have insisted that "we can keep providing substance use or sexual risk programs but until we get to the underlying cause - trauma - then we'll keep replacing one means of avoidance for another". This study will help address this community-generated clinical and empirical question. The overall goal is to compare two evidence based treatments, each addressing a different HSB causal pathway. NET addresses PTSD preventing SUD and HSB. MIST addresses substance misuse preventing SUD and HSB. Aim 1: To examine a PTSD versus a substance use-focused intervention to prevent HSB. We will conduct a two-arm randomized comparative effectiveness trial comparing NET (n=100) to MIST (n=100) among AI men and women with PTSD symptoms. We will evaluate the effect of reductions in PTSD severity and substance use (e.g., frequency, quantity, intentions, relapse, and initiation of use) on HSB (e.g., number of partners, sex while using substances, unprotected sex, and sex with high-risk partners) at post, 6, and 12-month follow-up. Aim 2: To examine theoretical mediators of treatment on HSB outcomes including emotional regulation, cognitive reappraisals, coping self-efficacy, communication skills, assertiveness, and community connectiveness.