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

描述（由申请人提供）：这是一个K23奖苏珊Meffert医学博士，公共卫生硕士，在加州大学旧金山分校精神病学助理教授重新提交。Meffert博士对中低收入国家（LMICs）情感创伤人群的研究建立了这个职业奖的建议，并提出了研究和培训目标，将她的工作重点放在艾滋病毒感染（HIV+）暴露于基于性别的暴力（GBV）（HIV + GBV+）的妇女身上。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而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计数下降相关。7 GBV的心理健康后遗症，包括创伤后应激障碍（PTSD）和抑郁症，是暴力，HAART依从性和不良艾滋病毒结局之间关系的理论介导者。7，8然而，如果没有对这些关系的数据驱动理解，我们无法开发出能有效改善极多艾滋病毒阳性妇女的整体健康状况的精神治疗方法。该提案通过对艾滋病毒阳性妇女进行大型纵向队列研究，并在高负担地区对艾滋病毒阳性性别暴力阳性妇女进行试点干预，解决了这一关键的知识差距。在国际公认的科学家的指导下，我提出了三个研究目标：目标1是在最大的受艾滋病毒影响的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介质进行纵向分析。我的共同导师，医学博士露丝格林布拉特，是N。WIHS研究的加州PI。基于我在肯尼亚艾滋病高发地区的UCSF家庭艾滋病护理教育和服务（FACES）计划的工作，目标2是适应一种既定的心理健康治疗（人际心理治疗[IPT]），用于FACES的HIV + GBV+妇女中的抑郁症和PTSD。目标3是一项试点研究，评估适应性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，为肯尼亚西部的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，我有一个成熟的，高效的现场研究团队。这一建议意义重大，因为它将产生对性别暴力、艾滋病毒后果和精神障碍的首次纵向分析，以及针对艾滋病毒+性别暴力+妇女的首次心理健康干预措施。这些研究可能会大大改善妇女的艾滋病毒方案，通过解决一个基本上尚未开发的心理健康途径影响艾滋病毒的结果GBV+妇女和开发/试行艾滋病毒+GBV+妇女的精神治疗。这些研究目标与我的培训目标紧密结合：（1）艾滋病纵向分析方法;（2）IPT适应性研究;（3）心理健康干预研究。这些研究将为R01资助的干预措施产生初步结果，该干预措施测试了适应性IPT对GBV对精神和艾滋病毒结果影响的功效。

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.