Gender Based Violence and HIV Outcomes: Tracking and Treating Mental Illness

描述（由申请人提供）：这是Susan Meffert医学博士，公共卫生硕士，UCSF精神病学助理教授的K23奖的再次提交。这项职业奖提案建立在Meffert博士对低收入和中等收入国家（LMICs）情感创伤人群的研究基础上，并提出了研究和培训目标，将她的工作重点放在遭受性别暴力（GBV） （HIV+GBV+）的艾滋病毒感染（HIV+）妇女身上。尽管人们知道，基于性别的暴力对身体健康有深远的不利影响（超过直接伤害）1-4，并且基于性别的暴力在艾滋病毒阳性妇女中非常普遍5,6，但人们对基于性别的暴力如何影响艾滋病毒的结果知之甚少。在横断面分析中，GBV与可检测的病毒载量（VL）和CD4计数下降有关性别暴力的精神健康后遗症，包括创伤后应激障碍（PTSD）和抑郁症，理论上是暴力、HAART治疗依从性和艾滋病毒治疗不良结果之间关系的中介因素然而，如果没有以数据为基础的对这些关系的理解，我们就无法开发出精神治疗方法，有效改善大量暴露于性别暴力的艾滋病毒+妇女的整体健康状况。该建议通过对艾滋病毒阳性妇女的大型纵向队列研究和对高负担地区艾滋病毒阳性性别暴力阳性妇女的试点干预来解决这一重要的知识差距。在国际知名科学家的指导下，我提出了三个研究目标：目标1是在最大的艾滋病毒感染妇女前瞻性队列研究（妇女机构间艾滋病毒研究[WIHS]）中对GBV、艾滋病毒结果和心理健康中介进行纵向分析。我的共同导师Ruth Greenblatt医学博士是WIHS研究的北加州PI。基于我在肯尼亚艾滋病毒高发地区与加州大学旧金山分校家庭艾滋病护理教育和服务（FACES）项目的工作，Aim 2是对face中艾滋病毒+GBV+女性抑郁症和创伤后应激障碍的既定心理健康治疗（人际心理治疗[IPT]）的改编。目标3是一项试点研究，评估经调整的IPT的可行性和可接受性。UCSF-FACES是一个由pepfar资助的护理和研究合作项目，为肯尼亚西部9万多名艾滋病毒感染者提供服务。FACES拥有强大的研究基础设施，我在现场有一个成熟的、高效的研究团队。这一建议意义重大，因为它将首次对性别暴力、艾滋病毒后果和精神障碍进行纵向分析，并首次对艾滋病毒+性别暴力+妇女进行调整和试点的精神健康干预。这些研究可能会通过解决影响GBV+妇女艾滋病毒结果的很大程度上尚未开发的心理健康途径，并开发/试点艾滋病毒+GBV+妇女的精神治疗，从而大大改善妇女艾滋病毒项目。这些研究目标与我的培训目标紧密结合：(1)HIV纵向分析方法；(2) IPT适应与(3)心理健康干预研究。这些研究将为一项由r01资助的干预措施提供初步结果，该干预措施将测试适应IPT对GBV对精神病学和艾滋病毒结果的影响的有效性。

DESCRIPTION (provided by applicant): This is a re-submission of a K23 award for Susan Meffert MD, MPH, Assistant Professor of Psychiatry at UCSF. This career award proposal builds on Dr. Meffert's research with emotionally traumatized populations in Low-and-Middle-Income Countries (LMICs) and proposes research and training goals to focus her work on HIV-infected (HIV+) women exposed to Gender-Based Violence (GBV) (HIV+GBV+). Despite knowledge that GBV has profound adverse effects on physical health (exceeding direct injury),1-4 and that GBV is highly prevalent among HIV+ women,5,6 little is known about how GBV affects HIV outcomes. In cross sectional analysis, GBV is associated with detectable viral load (VL) and decreased CD4 count.7 Mental health sequeale of GBV, including Posttraumatic Stress Disorder (PTSD) and depression, are theorized mediators of the relationships between violence, HAART adherence and poor HIV outcomes.7,8 However, without a data-driven understanding of these relationships, we are unable to develop psychiatric treatments that effectively improve the overall health of the extraordinary numbers of HIV+ women exposed to GBV. The proposal addresses this crucial knowledge gap using a large longitudinal cohort study of HIV+ women and a pilot intervention with HIV+GBV+ women in a high burden region. Mentored by internationally recognized scientists, I propose three research aims: Aim 1 is a longitudinal analysis of GBV, HIV outcomes and mental health mediators in the largest prospective cohort study of HIV- affected women (Women's Interagency HIV Study [WIHS]). My co-mentor, Ruth Greenblatt, MD, is the N. California PI for the WIHS study. Building on my work with the UCSF-Family AIDS Care Education and Services (FACES) program in a high HIV region of Kenya, Aim 2 is an adaptation of an established mental health treatment (Interpersonal Psychotherapy [IPT]) for depression and PTSD among HIV+GBV+ women at FACES. Aim 3 is a pilot study assessing feasibility and acceptability of the adapted IPT. UCSF-FACES is a PEPFAR-funded care and research collaboration serving more than 90,000 HIV+ individuals in western Kenya. FACES has robust research infrastructure and I have an established, highly productive research team onsite. This proposal is significant because it will generate the first longitudinal analysis of GBV, HIV outcomes and mental disorders, and the first mental health intervention adapted and piloted for HIV+GBV+ women. These studies may substantially improve women's HIV programs by addressing a largely untapped mental health pathway affecting HIV outcomes among GBV+ women and developing/piloting a psychiatric treatment for HIV+GBV+ women. These research aims are tightly integrated with my training goals: (1) Longitudinal analytic methods in HIV; (2) IPT adaptation and (3) Mental health intervention research. These studies will generate preliminary findings for an R01-funded intervention testing the efficacy of adapted IPT for the effects of GBV on psychiatric and HIV outcomes.