An integrated substance use, violence, and HIV/AIDS syndemic risk-reduction intervention for African American Couples

针对非裔美国夫妇的综合药物使用、暴力和艾滋病毒/艾滋病流行病风险降低干预措施

• 批准号: 9410847
• 负责人: Mona Mittal
• 金额: $ 14.63万
• 依托单位: UNIV OF MARYLAND, COLLEGE PARK
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9410847
• 关键词: AIDS/HIV problem; Acquired Immunodeficiency Syndrome; Address; African American; Alcohol or Other Drugs use; Anal Sex; Area; Battered Women; Behavior; Behavior assessment; Behavioral; Biological Testing; Cognitive; Communities; Consent; Couples; Couples Therapy; Data; Diagnosis; Drug abuse; Drug usage; Elements; Gender; Goals; HIV; HIV Infections; HIV Seropositivity; HIV risk; Heterosexuals; Incidence; Infection; Intervention; Interview; Journals; Link; Literature; Low income; Measures; Mediating; Mentored Research Scientist Development Award; Mission; NIH Office of AIDS Research; Outcome; Participant; Pilot Projects; Population; Positive Reinforcements; Protocols documentation; Public Health; Publishing; Random Allocation; Randomized; Randomized Clinical Trials; Recruitment Activity; Reporting; Research; Research Personnel; Research Priority; Risk; Risk Factors; Risk Reduction; Safety; Sexual Partners; Structure; Test Result; Testing; United States; Unsafe Sex; Vagina; Victimization; Violence; Woman; Work; base; career; condoms; experience; follow up assessment; gender disparity; health disparity; health inequalities; high risk; high risk sexual behavior; informant; innovation; intimate partner violence; novel; post intervention; racial disparity; revictimization; satisfaction; screening; sex risk; theories; transmission process; treatment as usual

PROJECT SUMMARY/ABSTRACT Synergistic interactions between substance use, violence and HIV/AIDS (SAVA syndemic) are closely linked with HIV acquisition in the African American (AA) population. However, no interventions have been developed to address SAVA syndemic risk-reduction for currently HIV-negative but high-risk heterosexual AA couples in the United States (US). This application is focused on adapting and pretesting the feasibility and acceptability of a couple-based SAVA syndemic informed risk-reduction intervention for HIV-negative, AA heterosexual couples who report high-risk sexual behaviors, intimate partner violence (IPV, perpetration and/or victimization), and substance (drug) use. The proposed work builds on the results from a previous K01 award that developed an integrated IPV-HIV risk-reduction intervention among low-income urban abused women. Specifically, findings showed promising impact of the intervention, but also indicated the importance of expanding its scope to incorporate substance use and involve women’s steady partners in the intervention. The proposed research includes two specific aims focused on adapting a SAVA informed intervention for high-risk AA heterosexual couples (aim 1) and pilot testing the resulting HIV risk-reduction intervention (aim 2). The adaptation of the intervention will be guided by Cognitive-Behavioral Theory (CBT) with specific intervention elements drawn from Cognitive Behavioral Couple Therapy (CBCT) and Behavioral Activation (BA). Year 1 of the project will be focused on conducting key informant interviews with 30 AA couples who report high-risk sexual behaviors, IPV, and substance use and adapting the SAVA syndemic informed HIV risk-reduction intervention for AA couples. A portion of year 1 and year 2 of the project will involve a randomized clinical trial (RCT) with 40 AA couples randomized to the SAVA informed risk-reduction intervention (20) or treatment as usual (20) using a random allocation sequence of group assignments within blocks of 10 that will be created using SAS. Participants will complete pre- and 3-month post-intervention behavioral assessments to measure changes in condom use, IPV, and substance use and biological testing for STIs. Percentage of couples who consent to participate, intervention attendance, intervention satisfaction, revictimization due to study participation, and percentage of couples who return for 3-month follow-ups will be tracked to determine feasibility and acceptability of the adapted intervention. Given the disproportionate impact of HIV on AAs in the US, this study addresses a key gap in literature by adapting and testing the first SAVA informed risk-reduction intervention for high-risk, HIV-negative, heterosexual AA couples. It is expected that the proposed intervention will help in addressing a NIH and Office of AIDS Research (OAR) high priority research area, “to reduce health disparities in the incidence of new HIV infections” with its focus on a highly vulnerable and marginalized group in the US and co-occurring HIV-related risk factors among couples.

项目摘要/摘要 药物使用、暴力和艾滋病毒/艾滋病之间的协同作用密切相关 在非裔美国人(AA)人群中感染艾滋病毒。然而，没有任何干预措施 旨在解决目前HIV阴性但高危异性AA患者的SAVA共同风险降低问题 美国的情侣。本应用的重点是适配和预试可行性和 基于夫妇的SAVA联合信息降低HIV阴性风险干预措施的可接受性， 报告高危性行为、亲密伴侣暴力(IPV、性行为)的异性伴侣 和/或受害)和物质(毒品)使用。拟议的工作建立在上一次 K01奖，在低收入城市中开发了综合IPV-HIV降低风险干预措施 被虐待的女人。具体地说，调查结果显示了干预的良好影响，但也表明 扩大其范围以纳入药物使用和让妇女的稳定伴侣参与 干预。拟议的研究包括两个具体目标，重点是适应Sava知情的 对高危再生障碍性贫血异性伴侣的干预(目标1)和试点测试由此产生的艾滋病毒风险降低 干预(目标2)。干预的适应将以认知-行为理论(CBT)为指导 从认知行为夫妇疗法(CBCT)和行为疗法中提取特定干预要素 激活(BA)。该项目的第一年将侧重于与30名AA进行关键线人面谈 报告高危性行为、IPV和物质使用的夫妇和适应SAVA综合征 针对再生障碍性贫血夫妇的知情艾滋病毒风险降低干预。项目第一年和第二年的一部分将 涉及一项随机临床试验(RCT)，40对AA夫妇随机接受SAVA知情风险降低 干预(20)或照常治疗(20)使用内的组分配的随机分配序列 将使用SAS创建的10个数据块。参与者将完成干预前和干预后3个月 行为评估，以衡量避孕套使用、IPV和物质使用的变化，并对 性传播疾病。同意参与的夫妇百分比、干预出勤率、干预满意度、 由于参与学习而再次受害，以及返回进行3个月随访的夫妇的百分比为 跟踪以确定适应干预的可行性和可接受性。考虑到不成比例的影响 这项研究通过改编和测试第一个SAVA来解决文献中的一个关键空白 针对高危、HIV阴性、异性恋AA夫妇的知情降低风险干预。预计 拟议的干预将有助于解决国家卫生研究院和艾滋病研究办公室(OAR)的高度优先事项 研究领域，“减少艾滋病毒新感染病例的健康差距”，其重点是 美国高度脆弱和边缘化的群体以及夫妇中共同出现的艾滋病毒相关风险因素。