Cognitive Processing Intervention for HIV/STI and Substance Use among Native Wome

描述（由申请人提供）：许多美国印第安人（AI）妇女从未接受过因创伤事件，暴力暴露和虐待造成的严重心理健康问题的服务。 人工智能女性一生中患创伤后应激障碍（PTSD）的比例更高（20-23%），这通常与过度饮酒和危险的性行为同时发生。这些因素增加了感染人体免疫机能丧失病毒和性传播疾病（艾滋病毒/性传播疾病）的风险。在与部落合作伙伴的全面发展中，该应用程序响应“R34 PA-09-146：药物滥用预防试验准备的试点和可行性研究”，提出了一个为期3年的项目，以文化适应和试点经验支持的创伤为重点的治疗，PTSD的认知加工疗法（CPT），物质使用和艾滋病毒/性传播疾病的性风险行为50 AI妇女。此外，我们将评估在资源有限的部落保留地通过人工智能社区卫生工作者提供CPT的可行性，可接受性和治疗保真度。该项目在重点和方法上都具有创新性。它为研究不足和高度脆弱的人口提供了一种文化上敏感的干预措施。它将在文化上调整和修改以证据为基础的CPT干预措施，以解决健康风险行为（物质和酒精使用以及障碍和高风险性行为）。它的意义在于它有可能在创伤后应激障碍、药物使用治疗和人工智能妇女艾滋病毒/性传播感染预防领域推进科学。研究数据将有利于部落和农村社区以及精神卫生领域。最后，它旨在发展研究基础设施和心理健康治疗能力，为生活在农村环境中的人工智能妇女服务，这是一个面临艾滋病毒/艾滋病蔓延风险的群体。如果成功，该试点的结果将为更大规模的有效性试验提供证据。目标是AIM I。与部落伙伴充分合作，调整循证CPT干预措施。这将按照疾病预防控制中心的适应过程地图进行，并涉及与部落领导人，潜在消费者，提供者和卫生保健管理人员使用定性方法的形成性研究。AIM 2.评估由美国土著社区卫生工作者提供的这种干预措施在资源有限的农村保留地环境中的可行性和可接受性。AIM 3.在50名患有PTSD或亚阈值PTSD的性活跃和使用物质的AI女性中进行一项为期12个疗程、为期3个月的CPT干预的两组、单点等待名单随机对照试验。确定初步疗效并估计三个主要结局的效应量：（a）PTSD行为学;（B）物质使用;（c）高危性行为。 公共卫生相关性：这项研究的结果有可能在美国印第安妇女的创伤后应激障碍和物质障碍治疗和艾滋病毒/性传播感染预防领域推进科学。此外，它还可以告诉我们这种干预措施是否有可能减少艾滋病毒风险行为，并最终减少艾滋病毒在这个非常脆弱的群体中的传播。

DESCRIPTION (provided by applicant): Many American Indian (AI) women never receive services for serious mental health problems resulting from traumatic events, violence exposure and maltreatment. AI women suffer higher lifetime rates of Post-traumatic Stress Disorder (PTSD) (20-23%), that often co-occur with excessive drinking and risky sexual behaviors. These factors magnify risk for human immunodeficiency virus and sexually transmitted disease (HIV/STI). In full development with tribal partners, this application, in response to "R34 PA-09-146: Pilot and Feasibility Studies in Preparation for Drug Abuse Prevention Trials" proposes a 3-year project to culturally adapt and pilot an empirically supported trauma-focused treatment, Cognitive Processing Therapy (CPT) for PTSD, substance use and HIV/STI sexual risk behavior among 50 AI women. Additionally, we will assess the feasibility, acceptability and treatment fidelity of delivering CPT via AI community health workers in a resource-limited tribal reservation. This project is innovative in both its focus and its methods. It brings a culturally responsive intervention to an understudied and highly vulnerable population. It will culturally adapt and modify an evidence-based CPT intervention to address health risk behaviors (substance and alcohol use and disorder and high risk sexual behavior). Its significance lies in its potential to advance science in the area of PTSD, substance use treatment and HIV/STI prevention among AI women. Study data would benefit tribal and rural communities and the mental health field. Finally, it is geared toward developing the research infrastructure and mental health treatment capacity serving AI women living in rural settings, a group at risk for an expanding HIV/AIDS epidemic. If successful, findings from this pilot will provide evidence for a larger effectiveness trial. The AIMS are AIM I. Adapt the evidence-based CPT intervention in full collaboration with tribal partners. This will be done in accordance with the CDC's Map of Adaptation Process and involves formative research with tribal leaders, potential consumers, providers, and health care administrators using qualitative methodology. AIM 2. Assess this intervention delivered by Native American community health workers for feasibility and acceptability in a resource-limited rural reservation setting. AIM 3. Conduct a two-group, single-site waitlist randomized controlled pilot trial of a 12-session, 3-month CPT intervention among 50 sexually active and substance using AI women with PTSD or sub-threshold PTSD. Determine preliminary efficacy and estimate an effect size in terms of three primary outcomes: (a) PTSD symptomatology; (b) substance use; (c) high risk sexual behavior. PUBLIC HEALTH RELEVANCE: The results of this study have the potential to advance science in the area of PTSD and substance disorder treatment and HIV/STI prevention among American Indian women. Additionally, it could tell us whether such an intervention might have the potential to reduce HIV risk behaviors and, ultimately, the spread of HIV, in this very vulnerable group.