Women focused Encounters for Resilience, Independence, Strength and Eudaimonia (WE RISE)

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Project Abstract Women represent the majority of people living with HIV in the world. Yet the underrepresentation of women in HIV research persists despite them experiencing greater societal/social disparities of health (SSDoH) including HIV care access and poorer HIV outcomes when compared to men. The coming together of substance (ab)use, violence against women and girls (trauma), and AIDS/HIV (known as SAVA) in the context of SSDOH contributes to excess HIV associated morbidity in women living with and at risk for HIV. This proposal aims to improve HIV outcomes in women living with HIV (WLWH) by evaluating the effectiveness and implementation of a combination intervention addressing substance use, trauma, and HIV. We will employ a randomized Type1 Hybrid study evaluating the effectiveness of acceptance and commitment therapy, exercise, and social support delivered by peer navigators. Implementation strategies that carry the potential to address SSDoH (economic insecurity, limited healthcare access, limited community) that WLWH experience and may enhance sustainability and dissemination will be evaluated. Community-based organizations in four Ending the HIV Epidemic jurisdictions will employ the intervention for a total of 48 weeks per site. The first 24 weeks (research effectiveness) will include a randomized study of 40 WLWH and will evaluate the impact on HIV (ART adherence, % continuous viral suppression), substance use (days and amount of use), trauma (trauma symptoms) and factors common to all three conditions (mood, social disconnection) over time. Weeks 24-48 will include a research implementation phase guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework evaluating local barriers, facilitators, change in implementation strategies selected to address structural/social disparities of health and intervention adaptations using the the Framework for Recording Adaptations and Modifications-Enhanced (FRAME). The following aims will guide evaluation of our intervention referred to as women focused encounters for resilience, independence, strength and eudaimonia (WE RISE). Aim 1: Evaluate short (week 8) and longer term (weeks 12, 24) effectiveness of WE RISE on HIV (↑ ART adherence, ↑ % of participants with continuous viral suppression), trauma (↓ trauma symptoms), substance use (↓ days of substance use) and transdiagnostic factors such as mood (↓depression, ↓anxiety) and social connectedness. Aim 2: Document the WE RISE implementation process by characterizing reach, effectiveness, adoption, implementation and maintenance (RE-AIM) by site for 24 weeks. Aim 3: At completion of 24 and 48 weeks, transcreate alternate or additional implementation strategies that address local barriers and leverage facilitators to optimize the effectiveness, maintenance and broader dissemination of WE RISE and document site-specific adaptations FRAME.