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

工程摘要 妇女占世界艾滋病毒感染者的大多数。然而，妇女代表性不足， 艾滋病毒研究持续存在，尽管他们经历了更大的社会/社会健康差距（SSDoH），包括 与男性相比，艾滋病毒护理的获得和艾滋病毒结果较差。物质的聚集 （ab）在苏丹卫生部范围内的吸毒、暴力侵害妇女和女童（创伤）以及艾滋病/艾滋病毒（称为SAVA） 导致感染艾滋病毒和有感染艾滋病毒风险的妇女的艾滋病毒相关发病率过高。这项建议旨在 通过评估有效性和执行情况，改善感染艾滋病毒妇女的艾滋病毒防治成果 药物使用、创伤和艾滋病的综合干预。 我们将采用一项随机1型混合研究，评估接受和承诺的有效性 治疗、锻炼和同伴导航员提供的社会支持。执行战略， 解决SSDoH（经济不安全，医疗保健服务有限，社区有限）的潜力，WLWH 将对经验和可能加强可持续性和传播的经验进行评价。基于社区 四个终止艾滋病毒流行管辖区的组织将采用总共48周的干预措施 每个站点。前24周（研究有效性）将包括40名WLWH的随机研究， 评估对HIV（ART依从性、持续病毒抑制率）、物质使用（天数和 使用量）、创伤（创伤症状）和所有三种情况的共同因素（情绪、社会 断开连接）。第24-48周将包括一个研究实施阶段， 评估当地障碍的勘探、准备、实施和维持框架， 促进者，改变选定的执行战略，以解决健康和 使用增强的改编和修改记录框架进行干预改编 （框架）。以下目标将指导对我们称为“以妇女为重点”的干预措施的评估 为适应力，独立性，力量和eudaimonia（我们崛起）的遭遇。 目的1：评估WE RISE对HIV（↑ ART）的短期（第8周）和长期（第12、24周）有效性 依从性，持续病毒抑制的受试者百分比↑），创伤（↓创伤症状），物质使用 （物质使用天数↓）和转诊断因素，如情绪（抑郁↓，焦虑↓）和社会 连通性 目标2：通过描述覆盖范围、有效性、采用率， 实施和维护（RE-AIM），为期24周。 目标3：在完成第24周和第48周的培训后， 解决当地的障碍，并利用促进者来优化效率，维护和更广泛的 传播WE RISE并记录特定场地的适应性FRAME。

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.