Pilot trial of an intervention to increase HIV engagement and reduce Intimate Partner Violence among Black women living with HIV

旨在提高感染艾滋病毒的黑人妇女的艾滋病毒参与度并减少亲密伴侣暴力的干预措施试点试验

• 批准号: 10626954
• 负责人: Kamila ANISE Alexander
• 金额: $ 20.47万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10626954
• 关键词: Address; Adherence; Affect; Appointment; Attention; Behavior Therapy; Behavioral; Birth; Black race; Caring; Case Management; Child Sexual Abuse; Chronic; Cognitive; Cognitive Therapy; Communication; Communities; Community Health Aides; Diagnosis; Disclosure; Disparity; Documentation; Educational process of instructing; Enrollment; Epidemic; Exposure to; Female; Focus Groups; Fright; Gender; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; Health; Impairment; Intervention; Intervention Studies; Intervention Trial; Interview; Knowledge; Life; Link; Measures; Medical Records; Mental Health; Modeling; Newly Diagnosed; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Pilot Projects; Problem Solving; Process; Public Health; Quality of life; Randomized; Recommendation; Research; Resources; Rewards; Role; Safety; Schedule; Social support; Source; Spirituality; Stigmatization; Stress; Techniques; Testing; Thinking; Time; Training; Trauma; United States Health Resources and Services Administration; Viral; Viral Load result; Visit; Woman; acceptability and feasibility; aged; antiretroviral therapy; arm; black women; care providers; cisgender; clinical care; community burden; community organizations; coping; design; environmental stressor; experience; follow up assessment; follow-up; help-seeking behavior; improved; inclusion criteria; innovation; intervention refinement; intimate partner violence; medication compliance; physical conditioning; pilot trial; prevent; programs; promote resilience; psychologic; racial disparity; resilience; safety net; self reliance; sex; skills; social stigma; social stressor; therapy design; violence exposure

Black women living with HIV (LWH) continue to experience disparities in exposure to intimate partner violence (IPV) and sub-optimal HIV care engagement. Black women LWH are twice as likely to experience IPV than non-HIV infected Black women. IPV experiences among Black women LWH are associated with decreased access to social support resources and impaired mental and physical health. Many Black women LWH and exposed to IPV also experience chronic exposure to internalized and anticipated stigmas. HIV-related stigma is associated with low rates of HIV care engagement due to fears of disclosure. While IPV-related stigma can prevent women from planning for safety or engaging informal or formal resources. There has been limited attention to the role of IPV or the effects of stigma as a barrier to Black women engaging in HIV care. Cognitive behavioral approaches (CBA) are efficacious to reducing stigma, improving IPV safety strategies, and increasing HIV care engagement, yet interventions designed for Black women LWH and experiencing IPV are lacking. Furthermore, few CBA interventions leverage the existing resilience of Black women LWH using a sources of strength framework. The overarching aim of this research is to conduct: a) component testing of an intervention among Black women with lived experiences of HIV and IPV; and b) a pilot study to evaluate acceptability, feasibility and preliminary efficacy of a 7-session small group-based CBA intervention to reduce HIV and IPV stigma and subsequently increase IPV safety strategies and HIV care engagement. The intervention uses a mnemonic (COPE) to teach techniques to appraise social and environmental stressors which includes real and perceived HIV and IPV stigma, and strategies for altering distorted thinking, problem- solving, bolstering positive social support, and scheduling safety strategies linked to rewards. COPE is delivered by a trained community health worker, which allows for scalability. We will enroll and randomize 80 IPV-exposed Black women LWH into the experimental CBA or control condition. Inclusion criteria are: (a) self- report female sex at birth, (b) self-report Black race, (c) aged 18 to 44 (d) documentation of HIV positive status confirmed with Oraquick test, (e) recent IPV exposure (12 months) as measured by HARK score >=1, (f) self- report <=1 HIV care appointment in previous 12 months. All participants will complete an immediate post- condition, 3 and 6-month follow-up assessments. The overall impact of this innovative intervention is high: it addresses the impact of violence exposure on HIV care engagement among Black women LWH, a priority of the NHAS. The proposed study is relevant to the persistent HIV epidemic that disproportionately impacts Black women LWH. The study intervention is scalable and easily implemented by community-based organizations and health departments.

感染艾滋病毒的黑人妇女（LWH）在遭受亲密伴侣暴力方面仍然存在差异 (IPV)和次优的艾滋病毒护理参与。黑人女性LWH经历IPV的可能性是女性的两倍。 未感染艾滋病毒的黑人妇女。黑人女性LWH的IPV经历与减少 获得社会支助资源和身心健康受损。许多黑人妇女LWH和 暴露于IPV的人也会长期暴露于内化和预期的耻辱。艾滋病毒有关的羞辱 与艾滋病毒护理参与率低有关，因为担心披露。虽然与IPV相关的耻辱感可以 防止妇女为安全进行规划或利用非正式或正式资源。发生了有限 注意IPV的作用或耻辱的影响，作为黑人妇女参与艾滋病毒护理的障碍。 认知行为方法（CBA）可以有效地减少污名，改善IPV安全策略， 和增加艾滋病毒护理的参与，但为黑人妇女LWH和经历IPV而设计的干预措施 缺乏。此外，很少有基于成本效益的干预措施利用黑人妇女LWH的现有复原力， 力量的来源框架。本研究的总体目标是进行：a）组件测试， 对有艾滋病毒和IPV经历的黑人妇女进行干预;和B）一项试点研究， 一个7节小团体为基础的CBA干预，以减少可接受性，可行性和初步疗效 艾滋病毒和IPV的耻辱，并随后增加IPV安全战略和艾滋病毒护理的参与。的 干预使用记忆法（科普）来教授评估社会和环境压力源的技术 其中包括真实的和感知的艾滋病毒和IPV耻辱，以及改变扭曲的思维，问题， 解决问题，支持积极的社会支持，并安排与奖励相关的安全策略。科普是 由经过培训的社区卫生工作者提供，这允许可扩展性。我们将招募并随机抽取80名 暴露于IPV的黑人女性LWH进入实验CBA或对照条件。入选标准是：（a）自我- 出生时报告女性，（B）自我报告黑人，（c）年龄在18至44岁之间，（d）艾滋病毒阳性状态的文件 经Oraquick测试确认，（e）近期IPV暴露（12个月），通过HARK评分≥ 1测量，（f）自身 在过去12个月内报告<=1次艾滋病毒护理预约。所有参与者将立即完成一个职位- 病情、3个月和6个月随访评估。这一创新性干预的总体影响很大： 解决暴力暴露对黑人妇女艾滋病毒护理参与的影响，LWH是一个优先事项， NHAS。拟议的研究与持续的艾滋病毒流行有关， 黑人妇女LWH。研究干预措施可扩展，易于由社区实施 组织和卫生部门。