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

描述(由申请人提供)：这是对加州大学旧金山分校精神病学助理教授、医学博士、公共卫生硕士苏珊·梅弗特的K23奖项的重新提交。这项职业奖励建议建立在梅弗特博士对中低收入国家(LMIC)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暴露于基于性别的暴力(GBV)(HIV+GBV+)的艾滋病毒感染(HIV+)女性身上。尽管知道基于性别的病毒对身体健康有深远的不利影响(超过直接伤害)，1-4而且基于性别的病毒在艾滋病毒+妇女中非常普遍，5，6人们对基于性别的病毒如何影响艾滋病毒的结果知之甚少。在横断面分析中，GBV与可检测到的病毒载量(VL)和CD4计数下降有关。7 GBV的精神健康后遗症，包括创伤后应激障碍(PTSD)和抑郁症，是暴力、遵守HAART和糟糕的艾滋病毒结果之间关系的理论中介。7.8然而，如果没有对这些关系的数据驱动的了解，我们就无法开发有效改善暴露于GBV的非常数量的艾滋病毒+妇女的整体健康的精神疗法。该提案通过对艾滋病毒+妇女进行大规模纵向队列研究，并在高负担地区对艾滋病毒+GBV+妇女进行试点干预，解决了这一关键的知识差距。在国际公认科学家的指导下，我提出了三个研究目标：目标1是对受艾滋病毒影响的妇女进行的最大前瞻性队列研究(妇女机构间艾滋病毒研究[WIHS])中对GBV、艾滋病毒结果和精神健康中介因素的纵向分析。我的另一位导师，医学博士露丝·格林布拉特，是WIHS研究的北加州PI。在我与加州大学旧金山分校-家庭艾滋病护理教育和服务(FACES)计划在肯尼亚艾滋病毒高发区合作的基础上，AIM 2是对Face上HIV+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是一项试验性研究，评估调整后的IPT的可行性和可接受性。加州大学旧金山分校-FACES是一个由PEPFAR资助的护理和研究合作项目，为肯尼亚西部超过9万名HIV+患者提供服务。Face拥有强大的研究基础设施，我在现场有一支成熟的、高生产率的研究团队。这一建议意义重大，因为它将产生第一个关于GBV、艾滋病毒后果和精神障碍的纵向分析，以及第一个针对艾滋病毒+GBV+妇女调整和试点的心理健康干预措施。这些研究可能会极大地改善妇女的艾滋病毒项目，解决在GBV+妇女中影响艾滋病毒结果的很大程度上未被开发的精神健康途径，并为艾滋病毒+GBV+妇女开发/试点精神疗法。这些研究目标与我的培训目标紧密结合在一起：(1)艾滋病毒的纵向分析方法；(2)IPT适应；(3)心理健康干预研究。这些研究将为一项由R01资助的干预措施产生初步结果，以测试适应的IPT对GBV对精神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.