Defining intervention targets along pathways from cumulative stress and trauma to alcohol and HIV self-management among young people living with HIV (Project DEFINE)

1艾滋病毒携带者青年自我管理不良的风险很高， 2可检测到的病毒载量为88%，以及危险饮酒，这可能会对艾滋病毒产生负面影响 3治疗与预防级联。改善两种酒的自我管理的干预措施 4使用和艾滋病毒护理是至关重要的，但收效有限，部分原因是未能说明 5针对这一人群特有的发展和文化特征以及压力和创伤 6由这些特点赋予的。青少年儿童不成比例地是种族、民族和性别 7经历慢性和复杂压力和创伤来源的比率较高的少数族裔 8在他们的一生中。此外，还有与以下有关的压迫性压力和创伤来源 9他们的种族、族裔、性和性别认同以及艾滋病毒状况，如歧视， 10系统性结构和社会不平等造成的微侵犯和耻辱。虽然 11压力与饮酒和疾病管理有关，这些都是其背后的途径 青瓦台之间的12个链接知之甚少。有证据表明，有几个可修改的因素 13可能在这些间接途径中发挥作用。压力一直与睡眠健康状况不佳有关， 14这可能会影响饮酒和艾滋病毒的自我管理，因为睡眠不好会 15关于情绪调节。行为调控(例如，决策、抑制性控制)是核心 16自我管理的组成部分，并可类似地在累积 17压力和酒精使用。与P01改善自我管理的总体目标一致 18%的酒精使用和艾滋病毒护理，该项目将在发展和 在累积应激之间的因果通路中的19个文化相关的可修改的干预目标 20和妇幼保健院的自我管理成果，其中大多数是跨部门的 21个压力和创伤来源。利用创新的外展方式，我们将招收300名不同的学生 22 YPLWH年龄18-29岁，完成对累积和并发压力、创伤、睡眠的调查 23健康(即使用电子睡眠日记进行调查和生态瞬时分析[EMA])， 24情绪和行为调节，以及药物使用和艾滋病毒结果 25个月。此外，少数青年妇女不太可能接受筛查，也不太可能获得 26项干预措施。在第五年，我们将使用混合方法，与 27个社区成员开发一套适应可扩展的干预措施的工具包 28.瞄准目标。由此产生的知识和工具有可能改善健康结果和 29未得到充分服务的青年的生活质量，他们往往无法从艾滋病毒护理方面的进展中受益 30通过处理与它们唯一相关的因素。

1 Young people living with HIV (YPLWH) are at high risk for poor HIV self-management, with 2 detectable viral load in 88%, and for hazardous alcohol use which can negatively impact the HIV 3 treatment and prevention cascade. Interventions to improve self-management of both alcohol 4 use and HIV care are critical but have had limited success in part due to the failure to account 5 for developmental and cultural characteristics unique to this population and stress and trauma 6 conferred by these characteristics. YPLWH are disproportionately racial, ethnic and sexual 7 minorities who experience higher rates of chronic and complex sources of stress and trauma 8 throughout their lives. Additionally, there are oppressive sources of stress and trauma related to 9 their racial, ethnic, sexual, and gender identities and HIV status, such as discrimination, 10 microaggressions, and stigma as a result of systemic structural and societal inequities. Although 11 stress has been linked to alcohol use and disease management, the pathways underlying these 12 links among YPLWH are poorly understood. Evidence suggests several modifiable factors that 13 may play a role in these indirect pathways. Stress has been associated with poor sleep health, 14 which may impact alcohol use and HIV self-management through the effect that poor sleep has 15 on emotion regulation. Behavioral regulation (e.g., decision-making, inhibitory control), is a core 16 component of self-management and may similarly mediate associations between cumulative 17 stress and alcohol use. Consistent with the overall goal of the P01 to improve self-management 18 of alcohol use and HIV care among YPLWH, this project would define developmentally and 19 culturally relevant, modifiable intervention targets in causal pathways between cumulative stress 20 and self-management outcomes among YPLWH, most of whom are subject to intersectional 21 sources of stress and trauma. Using innovative outreach methods, we will enroll 300 diverse 22 YPLWH age 18-29 to complete surveys of cumulative and intercurrent stress and trauma, sleep 23 health (i.e., survey and ecological momentary analysis [EMA] using an electronic sleep diary), 24 emotion and behavioral regulation, and substance use and HIV outcomes at baseline, 9 and 18 25 months. Further, minority YPLWH are less likely to be screened for or have access to available 26 interventions. In the fifth year, we will use a mixed methods approach in collaboration with 27 community members to develop a toolkit of adapted scalable measures for intervention 28 targeting. The resulting knowledge and tools have the potential to improve health outcomes and 29 quality of life for underserved youth who often may not benefit from advances in HIV care 30 through addressing factors uniquely relevant to them.