Striving Towards Empowerment and Medication Adherence (STEP-AD)

描述(由申请人提供)：在美国，黑人妇女占所有新诊断的妇女艾滋病毒的63%，种族/少数民族妇女中遵守抗逆转录病毒治疗的估计在45%至%之间，低于建议的水平。不适当的抗逆转录病毒治疗比率可能是由于感染艾滋病毒的黑人妇女面临的相关心理社会和背景因素，如虐待/创伤史、创伤后应激、种族歧视、与艾滋病毒有关的耻辱/歧视以及规定的女性传统性别角色；每一种因素都与更糟糕的艾滋病毒结果有关。目前还没有针对感染艾滋病毒的黑人妇女的基于证据的心理社会干预措施，来解决这些背景因素以提高抗逆转录病毒治疗的依从性。候选人：我是马萨诸塞州总医院/哈佛医学院的非裔美国人心理学研究员，有14本同行评议的出版物和章节(7篇第一作者)，内容涉及感染艾滋病毒的妇女和种族/少数民族中的心理社会因素(如创伤、歧视、性别角色)和健康结果(如对艺术的坚持)。目前的提议将使我能够获得必要的技能，成为一名独立研究人员，制定预防和干预战略，以促进感染艾滋病毒或有感染艾滋病毒风险的少数族裔的积极健康结果。指导：主要导师Steven Safren博士在艾滋病毒自我护理干预措施(例如，坚持抗逆转录病毒治疗)的背景下，具有解决心理社会问题的专长。Laura Bogart博士和Conall O‘Cleirigh博士是共同导师，他们在歧视感染艾滋病毒的非裔美国人和将创伤战略纳入艾滋病毒干预措施方面增加了各自的专业知识。研究：当前研究的目的是开发和评估干预措施的可行性和可接受性，通过结合基于证据的减少创伤症状的战略、应对种族和艾滋病毒相关歧视的战略、性别赋权、解决服药依从性的问题技术和弹性应对来改善感染艾滋病毒的黑人妇女的服药依从性。具体的研究目标是：(1)制定干预措施并进行干预的开放试点试验(N=10)，以初步评估所有研究程序和干预交付的可行性、可接受性以及在ART依从性和假想的心理社会介体方面潜在的临床显著改善，(2)进行试点随机对照试验(RCT)，比较新开发的治疗(N=25)和常规治疗(N=25)对ART依从性(主要结果)和病毒载量(次要结果)的影响，以及(3)通过参与(例如定性访谈，与社区成员和潜在的干预者(例如，个案管理人员)进行合作。培训：通过课程作业、研讨会和导师指导，我将实现三个培训目标：(1)提高为少数族裔制定艾滋病毒干预措施的技能，(2)获得社区参与和实施研究的技能，以及(3)发展高级纵向统计能力。

 DESCRIPTION (provided by applicant): In the U.S. Black women represent 63% of all new HIV diagnoses among women and estimates of adherence to ART among racial/ethnic minority women are between 45% and 64%, 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. 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.