Alcohol Epidemiology and Pilot Intervention to Reduce Alcohol, IPV and HIV in Women in Uganda

 描述(由申请人提供)：拟议的导师研究科学家发展奖(K01)的目的是为候选人提供培训和研究经验，以促进她作为一名独立研究人员的发展，特别是在撒哈拉以南非洲酒精使用人群中基于医疗保健的艾滋病毒干预研究领域。这一培训将使她有机会发展以下方面的知识和技能：1)酒精和药物滥用流行病学、评估和预防；2)在新的和现有的艾滋病毒感染的背景下，以理论为导向的行为干预措施，以减少有害的酒精使用和亲密伴侣暴力(IPV)；以及3)高级统计分析技术，如结构方程建模。培训活动将包括授课课程和具体的研讨会，定向阅读和与导师的一对一辅导，以及负责任的研究行为指导。候选人将接受一个培训委员会的指导，该培训委员会由酒精和其他物质滥用、艾滋病毒预防、基于医疗保健的酒精筛查和简短干预(SBI)和流行病学研究领域的全球知名专家组成。她的应用研究培训将在乌干达Rakai进行，在Rakai Health Science Program(RHSP)的现有基础设施内进行，Rakai Health Science Program(RHSP)是一个已有25年历史的艾滋病毒研究和服务提供组织。拉凯区毗邻维多利亚湖，是几个酗酒和艾滋病毒流行率极高的渔业社区的所在地。在Rakai，IPV的发生率很高，并与酒精和艾滋病毒有关。酒精、IPV和艾滋病毒之间的因果关系尚不清楚。拟议的研究将被纳入Rakai社区队列研究(RCCS)，这是世界上最古老和成熟的基于人群的队列研究之一(5U01AI100031-03；5R01HD070769；5R01MH099733)。具体目的是进行二次RCCS数据分析，以：1)估计成年妇女酒精使用的当前流行率和决定因素，以及2)检查成年妇女酒精、IPV和艾滋病毒感染之间的联系以及直接和间接途径。其他目标是3)对女性艾滋病毒咨询和检测(HCT)客户进行定性访谈(n=20)，并与HCT顾问和监督员进行焦点小组(n=2)，以评估将酒精和IPV SBI纳入RHSP的标准HCT模型的看法；以及4)利用AIMS 1-3的定量和定性结果，对80名来自农村信用社的受虐、酗酒、寻求检测后艾滋病毒咨询的女性进行酒精和IPV SBI的调整和试点测试。结果将生成为随后的大规模有效性试验的功率计算提供信息所需的参数的效果估计，并将使候选人能够开发R34或R01应用程序以提交给NIAAA。这项拟议的工作支持2014财年跨国立卫生研究院艾滋病毒相关研究计划，通过开展“解决酒精和其他药物对可能导致艾滋病毒传播和感染的性行为的影响的干预研究”来减少新的感染。

 DESCRIPTION (provided by applicant): The purpose of the proposed Mentored Research Scientist Development Award (K01) is to provide the candidate with training and research experiences that will promote her development as an independent researcher, with particular emphasis in the field of healthcare-based HIV intervention research with alcohol- using populations in sub-Saharan Africa. This training will provide her with the opportunity to develop knowledge and skills in: 1) alcohol and substance abuse epidemiology, assessment and prevention; 2) theoretically-driven behavioral interventions to reduce harmful alcohol-use and intimate partner violence (IPV), in the context of new and existing HIV infections; and 3) advanced statistical analytic techniques such as structural equation modeling. Training activities will include didactic coursework and specific workshops, directed readings and one-on-one tutorials with mentors, and instruction in the responsible conduct of research. The candidate will receive mentorship from a Training Committee comprised of globally renowned experts in the fields of alcohol and other substance abuse, HIV prevention, healthcare-based alcohol screening and brief interventions (SBI) and epidemiology research. Her applied research training will take place in Rakai, Uganda within the existing infrastructure of the Rakai Health Sciences Program (RHSP), a 25 year old HIV research and service provision organization. Rakai District is bordered by Lake Victoria and home to several fishing communities with extremely high prevalence of alcohol use and HIV. Rates of IPV are high in Rakai and associated with alcohol and HIV in women the causal pathways between alcohol, IPV, and HIV are unknown. The proposed research will be embedded in the Rakai Community Cohort Study (RCCS), one of the oldest and well-established population-based cohort studies in the world (5U01AI100031-03; 5R01HD070769; 5R01MH099733). Specific aims are to conduct secondary RCCS data analysis to: 1) estimate current prevalence and determinants of alcohol use in adult women and 2) examine associations and direct and indirect pathways between alcohol, IPV and HIV infection in adult women. Other aims are to 3) conduct qualitative interviews (n=20) with female HIV counseling and testing (HCT) clients, and focus groups (n=2) with HCT counselors and supervisors to assess perceptions of integrating an alcohol and IPV SBI into RHSP's standard HCT model; and 4) use quantitative and qualitative findings from Aims 1-3 to adapt and pilot test an alcohol and IPV SBI with 80 abused, alcohol-using women, drawn from RCCS, who seek post-test HIV counseling. Results will generate effect estimates for parameters needed to inform power calculations for a subsequent, large-scale effectiveness trial and will position the candidate to develop an R34 or R01 application for submission to NIAAA. The proposed work supports the FY2014 Trans-NIH Plan for HIV-Related Research to reduce new infections by conducting "intervention research that addresses the impact of alcohol and other drugs on sexual encounters that may contribute to HIV transmission and acquisition."