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%，少数种族/民族妇女坚持抗逆转录病毒治疗的估计在45%到64%之间，低于建议水平。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所面临的相关社会心理和环境因素，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社会心理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/哈佛医学院的一名非裔美国心理学研究员，有14篇同行评议的出版物和章节（7篇第一作者），内容涉及女性和少数种族/族裔感染艾滋病毒的心理社会因素（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）。目前的建议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，促进感染艾滋病毒或有感染艾滋病毒风险的种族/族裔少数群体取得积极的健康成果。指导：主要导师Steven Safren博士在解决艾滋病毒自我保健干预措施（例如坚持抗逆转录病毒药物治疗）背景下的社会心理问题方面具有专长。Drs。Laura Bogart和Conall O’cleright是共同导师，他们各自在非裔美国人感染艾滋病毒的歧视以及将创伤策略整合到艾滋病毒干预中增加了专业知识。研究：本研究的目的是开发和评估一种干预措施的可行性和可接受性，通过结合以证据为基础的创伤症状减轻策略、应对种族和艾滋病毒相关歧视的策略、性别赋权、药物依从性的问题解决技术和弹性应对，来改善感染艾滋病毒的黑人妇女的药物依从性。具体研究目的有：(1)制定一项干预措施，并对该干预措施进行公开试点试验（N=10），以初步评估所有研究程序和干预措施的可行性、可接受性，以及对抗逆转录病毒治疗依从性和假设的社会心理介质的潜在临床显著改善；(2)开展一项试验性随机对照试验（RCT），比较新开发的治疗方法（N=25）与常规对照强化治疗方法（N=25）在6个月内的抗逆转录病毒治疗依从性（主要结果）和病毒载量（次要结果）。(3)通过与社区成员和干预措施的潜在提供者（如病例管理人员）的接触（如定性访谈、干预示范），为在社区诊所开展一项充分有力的随机对照试验做准备。培训：通过课程、研讨会和指导，我将实现三个培训目标：(1)提高为少数种族/民族开发艾滋病干预措施的技能，(2)掌握社区参与和实施研究的技能，(3)提高高级纵向统计的能力。

 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.