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

描述（由申请人提供）：许多美国印第安妇女从未接受过因创伤事件、暴力暴露和虐待造成的严重精神健康问题的服务。AI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。这些因素加大了感染人类免疫缺陷病毒和性传播疾病（艾滋病毒/性传播疾病）的风险。为了响应“R34 PA-09-146：预防药物滥用试验准备的试点和可行性研究”，该申请与部落合作伙伴一起全面开发，提出了一个为期三年的项目，在50名AI妇女中进行文化适应和试点，以经验为基础，以创伤为重点的治疗，认知加工疗法（CPT），治疗创伤后应激障碍，药物使用和艾滋病毒/性传播感染风险行为。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。这个项目在重点和方法上都是创新的。它为未被充分研究和高度脆弱的人群带来了文化响应性干预。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（药物和酒精使用以及紊乱和高风险性行为）。它的重要意义在于它有可能在AI妇女中推进创伤后应激障碍、药物使用治疗和艾滋病毒/性传播感染预防领域的科学。研究数据将有利于部落和农村社区以及心理健康领域。最后，它的目标是发展研究基础设施和心理健康治疗能力，为生活在农村地区的人工智能妇女服务，这一群体面临艾滋病毒/艾滋病流行病扩大的风险。如果成功，该试验的结果将为更大规模的有效性试验提供证据。目标是：目标一：与部落伙伴充分合作，采用循证的CPT干预措施。这将根据疾病预防控制中心的适应过程地图进行，并涉及使用定性方法与部落领导人、潜在消费者、提供者和卫生保健管理人员进行形成性研究。目标2。评估由美洲原住民社区卫生工作者提供的干预措施在资源有限的农村保留环境中的可行性和可接受性。目标3。对50名患有PTSD或亚阈值PTSD的性活跃和物质使用AI的女性进行12个疗程、3个月的CPT干预的两组、单点等待名单随机对照试验。根据三个主要结局确定初步疗效并估计效应大小：(a) PTSD症状；(b)物质使用；(c)高危性行为。

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.