Striving Towards Empowerment and Medication Adherence (STEP-AD)

描述（由申请人提供）：在美国，黑人妇女占妇女中所有新诊断艾滋病毒的63%，少数种族/民族妇女坚持抗逆转录病毒治疗的估计数在45%至64%之间，低于推荐水平。抗逆转录病毒治疗率不足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、创伤后压力、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;其中每一个都与更糟糕的艾滋病毒结局有关。目前没有针对感染艾滋病毒的黑人妇女的循证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疗法的依从性。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，发表了14篇同行评议的出版物和章节（7篇为第一作者），内容涉及感染艾滋病毒的妇女和少数民族的心理社会因素（如创伤、歧视、性别角色）和健康结果（如抗逆转录病毒治疗依从性）。本提案将使我获得必要的技能，成为一名独立的研究人员，制定预防和干预战略，以促进患有艾滋病毒或有艾滋病毒风险的种族/少数民族之间的积极健康成果。指导：Steven Safren博士是主要的导师，在解决艾滋病毒自我护理干预措施（例如抗逆转录病毒疗法依从性）背景下的心理社会问题方面具有专业知识。劳拉·博加特博士和康纳尔·奥克莱里博士是共同导师，他们在感染艾滋病毒的非洲裔美国人中的歧视问题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。研究人员：本研究的目的是开发和评估的可行性和可接受性的干预措施，以提高黑人妇女与艾滋病毒的药物治疗依从性相结合的循证策略，减少创伤症状，战略应对种族和艾滋病毒相关的歧视，赋予妇女权力，解决问题的技术，药物治疗依从性，和弹性的应对。具体的研究目标是：（1）开发干预措施并进行干预措施的开放性试点试验（N=10），以初步评估所有研究程序和干预措施实施的可行性、可接受性以及对ART依从性和假设的心理社会介质的潜在临床显著改善，（2）进行一项初步随机对照试验（RCT），比较新开发的治疗（N=25）与常规对照的增强治疗（N =25）对ART依从性的影响。（主要结局）和病毒载量（次要结局），以及（3）通过与社区成员和潜在干预提供者（例如病例管理者）的接触（例如定性访谈，干预演示），为在社区诊所开展充分的RCT做好准备。培训：通过课程，研讨会和导师，我将实现三个培训目标：（1）提高技能，为种族/少数民族制定艾滋病毒干预措施，（2）获得社区参与和实施研究的技能，（3）发展先进的纵向统计能力。

 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.