A Trauma-Informed Intervention for Sexual Minority Men Recently Diagnosed with HIV

项目总结/摘要 与美国的一般人群相比，艾滋病毒感染者（PLWH）的感染率很高， 创伤和应激相关疾病以及对诊断上不 被认为是创伤。创伤与抑郁症高度相关，抑郁症是抗逆转录病毒治疗的有力预测因素 (ART)不遵守。此外，报告大量近期压力事件与ART相关 不遵守。尽管黑人性少数群体男性（BSMM），特别是40岁以下的男性， BSMM受艾滋病毒和创伤的影响不成比例，并且不太可能与诊断后的艾滋病毒护理有关， 在心理健康方面严重不足。此外，尽管存在针对创伤的干预措施， 对于PWLH，很少有HIV相关的干预措施强调创伤性应激循环和急性应激反应 艾滋病诊断后立即进行。立即处理早期精神健康干预的需要 一般来说，在艾滋病毒诊断后，以及艾滋病毒+ BSMM（+BSMM）的心理健康需求未得到充分解决， 特别是，我们将开发和试点测试一个以服从为重点的，创伤知情的干预，称为恢复力， 缓解压力和艾滋病毒相关功效的基础干预（RISE）。RISE将基于 认知行为疗法（CBT）的方法和技术以及心理弹性理论的框架。它 将在艾滋病毒感染后三个月内解决创伤和压力相关的神经病学和急性应激反应问题。 诊断，以促进与艾滋病毒护理的联系。简短的RISE将包括六个在线会议，一个助推器会议， 发短信创新的商业营销技术将用于开发高度针对性的信息 以补充RISE基于CBT和服从性的方法。首先，目标1将涉及形成性研究， 评估+BSSM的需求，偏好，以及对他们的心理健康和参与的看法 通过与+BSMM和服务提供者的深入访谈进行艾滋病毒护理。下一步，目标2将包括开发 RISE干预手册和数字健康基础设施。量身定制的短信和健康促进 将通过与50多个BSMM进行深入访谈衍生的定量调查来开发材料。Aim还将 包括一个干预开发迭代过程，包括具有+BSMM和服务的焦点小组 提供者，分别和干预剧场测试6 +BSMM。最后，目标3将由随机的、 可行性的受控先导试验（例如，招募和登记率，忠诚度），可接受性（即，反馈 访谈，满意度调查表），和初步疗效（即，增加艾滋病毒护理参与，包括 参加艾滋病毒护理预约、抗逆转录病毒治疗[ART]启动和ART依从性[初级 结果];减少创伤症状，包括侵入性经历、回避和过度觉醒[继发性 结果]）在过去三个月内诊断出40 +BSMM。将在基线时对参与者进行评估， 干预后以及基线后6个月和9个月的随访。我们将发展和维护一个社区 咨询委员会在整个研究过程中进行咨询。

Project Summary/Abstract Compared to the general population in the United States, people living with HIV (PLWH) show high rates of trauma- and stress-related disorders and severe acute stress reactivity to events that are, diagnostically, not considered traumatic. Trauma is highly correlated with depression, a robust predictor of antiretroviral treatment (ART) non-adherence. Additionally, reporting a high number of recent stressful events is associated with ART non-adherence. Despite Black sexual minority men (BSMM), particularly those under age 40, being disproportionately affect by HIV and trauma and less likely to be linked to HIV care after diagnosis, BSMM remain grossly underserved with respect to their mental health. Further, although interventions exist that address trauma for PWLH, few HIV-related interventions emphasize the traumatic stress cycle and acute stress reactivity immediately following an HIV diagnosis. To address the need for early mental health intervention immediately after HIV diagnosis, in general, as well as the under-addressed mental-health needs of HIV+ BSMM (+BSMM), in particular, we will develop and pilot-test a resilience-focused, trauma-informed intervention called, Resilience- Based Intervention for Stress Reduction and HIV-Related Efficacy (RISE). RISE will be based on approaches and techniques of Cognitive-Behavior Therapy (CBT) and the framework of Resilience Theory. It will address trauma- and stress-related symptomology and acute stress reactivity within three months of an HIV diagnosis to facilitate linkage to HIV care. The brief RISE will include six online sessions, a booster session, and text messaging. Innovative commercial marketing techniques will be used to develop highly targeted messages to supplement the CBT- and resilience-based approach of RISE. First, Aim 1 will involve formative research to assess +BSSM's needs, preferences, and perceptions regarding their mental health and their engagement in HIV care via in-depth interviews with +BSMM and service providers. Next, Aim 2 will include development of the RISE intervention manual and digital health infrastructure. Tailored text messages and health-promotion materials will be developed via in-depth interview-derived quantitative surveys with 50 +BSMM. The Aim will also include an iterative process of intervention development, including focus groups with +BSMM and service providers, respectively, and intervention theatre tests with 6 +BSMM. Finally, Aim 3 will consist of a randomized, controlled pilot trial for feasibility (e.g., recruitment and enrollment rates, fidelity), acceptability (i.e., feedback interview, satisfaction questionnaire), and preliminary efficacy (i.e., increased HIV care engagement, including attending an HIV care appointment, antiretroviral treatment [ART] initiation, and ART adherence [primary outcome]; reduced trauma symptoms, including intrusive experiences, avoidance, and hyperarousal [secondary outcome]) with 40 +BSMM diagnosed within the past three months. Participants will be assessed at baseline, post-intervention, and 6- and 9-month follow-ups post-baseline. We will develop and maintain a community advisory board for consultation throughout the study.