Intervening with Haitian HIV+ Alcohol Abusers: An Environmental Psychosocial Fram

描述(由申请人提供)：这项拟议的研究是一项改编和随机试验，采用认知-行为压力管理(CBSM)干预措施，在海地以贫困为主的城市人口中同时加强安全的性行为实践，坚持抗逆转录病毒药物，并减少酒精或其他药物(AOD)的使用。与我们的现场临床研究合作伙伴GHESKIO中心一起，重点关注环境和心理社会(Env-PSY-Soc)因素对艾滋病毒干预结果的影响。在海地与GHESKIO一起进行这项研究提供了一个独特的机会，可以为海地和该区域正在进行的艾滋病毒/艾滋病预防和治疗的扩大作出贡献。盖斯基奥在海地和该地区是独一无二和无与伦比的，它是一家社会信任的传染病控制机构，自发现艾滋病毒病毒以来就一直在那里，并成功地将学术纪律严明的艾滋病毒/艾滋病临床研究和培训模式应用于海地的城市和农村社区。盖斯基奥使用类似于典型的美国退伍军人管理局中心的综合护理模式运营，并为反映资源受限国家疫情断层线的人口提供服务：贫困和丧失权力、混乱的城市化带来的创伤和暴力、频繁的内乱和不充分的法治。使用CBSM载体，一种潜在有效的预防干预措施，在这个临床场所降低艾滋病毒携带者(PLWH)的艾滋病毒传播风险，提高了成功的可能性。CBSM-A是待评估的适应性干预措施，基于NIH在海地进行的一项试点研究，该研究以信息-动机-行为(IMB)理论为指导。这是一个针对艾滋病毒AOD人群的小组设计，它还解决了他们的认知/自我管理和应对障碍，这些障碍可能会阻碍可持续结果，特别是在海地这样的资源有限的环境中。HLM/SEM分析将用于探索遵守安全性行为和抗逆转录病毒药物指南，以及传统的IMB变量、AOD使用和环境心理因素如何影响干预效果。拟议的项目响应了NIH关于整合环境-心理社会研究和临床研究与实践的优先事项，针对社区提供者所面临的“现实世界”条件，调整和转化了有效的基于研究的干预策略。如果成功，这项研究将提出一种艾滋病毒干预战略，可以在海地和其他资源有限的环境中为具有高风险行为(酒精使用和不安全的性行为)的艾滋病毒成年人实际实施，同时推进如何为这些环境量身定做干预措施的知识库。

DESCRIPTION (provided by applicant): The proposed study is an adaptation and randomized trial of a Cognitive-Behavioral Stress Management (CBSM) intervention for simultaneously enhancing safer sex practices, adherence to ARV medication, and reducing alcohol or other drugs (AOD) use, in a predominantly poor urban population in Haiti. With our on- site clinical research partner, the GHESKIO Centers, a key focus will be how HIV intervention outcomes are influenced by Environmental and PsychoSocial (Env-Psy-Soc) factors. Performing this study in Haiti with GHESKIO presents a unique opportunity to contribute an EnvPsySoc dimension to the HIV/AIDS prevention and treatment scale-up that is ongoing there and in the region. GHESKIO is unique and unparalleled in Haiti and the region as a socially trusted infectious disease control institution that has been there since the discovery of the HIV virus and that has successfully adapted an academically disciplined HIV/AIDS clinical research and training model into the urban and rural communities of Haiti. GHESKIO operates using an integrated care model similar to a typical U.S. VA center, and serves a population reflective of the fault lines of the epidemic in resource-constrained countries: poverty and disempowerment, the trauma and violence of chaotic urbanization and frequent civil disorder and inadequate rule of law. Using the vehicle of CBSM, a potentially efficacious prevention intervention for reducing HIV transmission risk among People Living with HIV (PLWH) in this clinical venue enhances the probability of success. CBSM-A, the adapted intervention to be evaluated, is based on an NIH pilot study in Haiti that was guided by Information-Motivation-Behavior (IMB) theory. It is a small-group design for HIV+ AOD using populations, which also addresses their cognitive/self management and coping barriers that may impede sustainable outcomes, particularly in resource-constrained settings as Haiti. HLM/SEM analyses will be used to explore adherence to safer sex and ARV medication guidelines as well as how intervention effects are influenced by traditional IMB variables, AOD use, and EnvPsySoc factors. The proposed project responds to the NIH priority on integrating environmental-psychosocial research and on bridging clinical research and practice, by adapting and translating effective research-based intervention strategies for the "real world" conditions faced by community based providers. If successful, this research will present an HIV intervention strategy that can be practically implemented for HIV+ adults with high risk behaviors (alcohol use and unsafe sexual practices) in Haiti and other resource-constrained settings, while advancing the knowledge base of how to tailor interventions for such settings.