Improving the health of South African women with traumatic stress in HIV care

描述（由申请人提供）：南非感染艾滋病毒的妇女报告性创伤率很高，这对她们的精神健康产生负面影响，并可能影响她们参与艾滋病毒护理（继续接受护理和坚持抗逆转录病毒治疗）和危险行为。解决性创伤造成的创伤性应激可以改善这些与艾滋病毒相关的结果，进而可能通过抑制病毒和减少艾滋病毒风险行为来预防艾滋病毒传播。在美国有创伤史的hiv感染人群中进行的干预研究表明，一种应对方法，特别是减少逃避型应对策略的使用，在减少创伤压力和改善健康行为方面是有效的。尽管南非面临艾滋病毒和性暴力的双重流行，但创伤治疗并没有很好地纳入艾滋病毒护理环境。这项为期3年的研究将开发并试点测试一项名为ImpACT（改善创伤后艾滋病护理）的干预措施，以减少逃避性应对、创伤压力和风险行为，并增加护理的参与度。干预措施将在公共抗逆转录病毒治疗诊所进行，并将针对开始接受抗逆转录病毒治疗的关键时期的妇女，以便最大限度地影响她们参与护理。与研究诊所的工作人员、提供者和感染艾滋病毒的女性患者进行定性数据收集，将获得关于ImpACT的内容和实施以及研究方案关键方面的反馈。然后，ImpACT将在60名有性创伤史和创伤压力升高的新ART参与者中进行试点。参与者将被随机分配到对照条件（标准治疗，或SoC：所有在诊所开始抗逆转录病毒治疗的患者需要3次依从性咨询会议）或干预条件（SoC + ImpACT），并将在随机化后的基线、3和6个月完成评估，并在研究期结束时从医疗记录中提取护理参与数据。该研究有三个具体目标：1)为南非艾滋病毒护理环境中有性创伤史的妇女制定一个简短且可扩展的应对干预措施；2)为一项可靠的随机对照试验建立实验方案的方法学细节；3)在60名有性创伤史、正在接受抗逆转录病毒治疗的感染艾滋病毒的妇女中试点测试ImpACT干预措施，以确定艾滋病毒护理环境中的可行性和可接受性。

DESCRIPTION (provided by applicant): HIV-infected women in South Africa report high rates of sexual trauma, which negatively impacts their mental health and potentially influences engagement in HIV care (retention in care and adherence to antiretroviral therapy) and risk behaviors. Addressing the traumatic stress resulting from sexual trauma could improve these HIV-related outcomes, which in turn may prevent HIV transmission through suppression of the virus and reduction in HIV risk behaviors. Intervention research among HIV-infected populations with trauma histories in the U.S. demonstrates that a coping approach, particularly one that reduces the use of avoidant coping strategies, is efficacious in reducing traumatic stress and improving health behaviors. Although South Africa faces dual epidemics of HIV and sexual violence, trauma treatment has not been well-integrated into the HIV care setting. The proposed 3-year study will develop and pilot test an intervention called ImpACT (Improving AIDS Care after Trauma) to reduce avoidant coping, traumatic stress, and risk behaviors, and increase engagement in care. The intervention will take place in a public ART clinic and will target women during the critical period when they initiate ART in order to maximize the impact on engagement in care. Qualitative data collection with staff, providers, and HIV-infected female patients at the study clinic will elicit feedback on the content and delivery of ImpACT and key aspects of the study protocol. ImpACT will then be piloted with 60 women who are new ART enrollees with a history of sexual trauma and elevated traumatic stress. Participants will be randomized to the control condition (standard of care, or SoC: 3 adherence counseling sessions required of all patients initiating ART at the clinic) or the intervention condition (SoC + ImpACT) and will complete assessments at baseline, 3, and 6 months post-randomization, with care engagement data extracted from medical records at the end of the study period. The study has three specific aims: 1) to develop a brief and scalable coping intervention for delivery in the South African HIV care setting for women with sexual trauma histories; 2) to establish the methodological details of an experimental protocol for a robust randomized control trial; and 3) to pilot test the ImpACT intervention with 60 HIV-infected women with histories of sexual trauma who are initiating ART in order to determine feasibility and acceptability in the HIV care setting, and explore the impact on avoidant coping, traumatic stress, engagement in care, and HIV risk behaviors. The goal at the completion of this study is to have a structured intervention curriculum that is culturally relevant for HIV infected women in South Africa, a full experimental protocol that is appropriate for the South African care setting, and data on feasibility, acceptability, and target outcomes. These products can be leveraged to inform an R01 application for rigorous evaluation of the ImpACT intervention. We are confident that this developmental work will significantly enhance the probability of success of a larger randomized control trial.