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

项目总结/摘要 本研究是一项认知-行为压力管理的适应性随机试验 （CBSM）干预，同时加强安全性行为，坚持抗逆转录病毒药物治疗， 减少酒精或其他药物（AOD）的使用，在海地主要是贫困的城市人口。我们的- 现场临床研究合作伙伴，GHESKIO中心，一个关键的重点将是艾滋病毒干预的结果是如何 受环境和心理社会（Env-Psy-Soc）因素的影响。在海地进行这项研究， GHESKIO提供了一个独特的机会，为艾滋病毒/艾滋病预防提供环境心理社会方面的帮助 以及该地区正在进行的治疗规模扩大。GHESKIO在海地是独一无二、无与伦比的 以及该地区作为一个社会信任的传染病控制机构， 发现了艾滋病毒，并成功地适应了学术纪律的艾滋病毒/艾滋病临床 在海地的城市和农村社区开展研究和培训模式。GHESKIO使用 综合护理模式类似于一个典型的美国VA中心，并为人口反映断层线， 资源有限国家的流行病：贫穷和丧失权力、 混乱的城市化和频繁的内乱以及法治不足。使用CBSM的车辆， 可能有效的预防干预措施，以减少艾滋病毒感染者之间的传播风险 艾滋病毒（PLWH）在这个临床场所提高了成功的可能性。CBSM-A，适应性干预 有待评估，是基于美国国立卫生研究院在海地的试点研究，是由信息-动机-行为 (IMB)理论这是一个针对HIV+ AOD的小群体设计，使用人群，也解决了他们的问题。 认知/自我管理和应对障碍，可能会阻碍可持续的成果，特别是在 像海地这样资源有限的国家。HLM/SEM分析将用于探索对安全性行为的依从性 和抗逆转录病毒药物治疗指南以及传统IMB变量如何影响干预效果， AOD使用和EnvPsySoc因素。拟议的项目响应了美国国立卫生研究院关于整合 环境-心理社会研究和桥接临床研究和实践，通过调整和 针对社区面临的“真实的世界”状况，采用有效的基于研究的干预战略 基于供应商。如果成功，这项研究将提出一种艾滋病毒干预战略， 在海地为艾滋病毒阳性的高危行为（酗酒和不安全的性行为）的成年人实施， 其他资源有限的情况下，同时推进知识基础， 设置.

Project Summary/Abstract 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.