Intervening with Haitian HIV+ Alcohol Abusers: An Environmental Psychosocial Fram

描述（由申请人提供）：拟议的研究是一项适应和随机试验的认知行为压力管理（CBSM）干预，同时加强安全性行为，坚持抗逆转录病毒药物治疗，并减少酒精或其他药物（AOD）的使用，在海地主要是贫困的城市人口。与我们的现场临床研究合作伙伴GHESKIO中心一起，重点关注艾滋病毒干预结果如何受到环境和心理社会（Env-Psy-Soc）因素的影响。与GHESKIO在海地进行这项研究提供了一个独特的机会，可以为正在那里和该地区进行的艾滋病毒/艾滋病预防和治疗规模的扩大贡献EnvPsySoc层面。GHESKIO在海地和该地区是独一无二的，是一个社会信任的传染病控制机构，自发现艾滋病毒以来一直存在，并成功地将学术纪律的艾滋病毒/艾滋病临床研究和培训模式融入海地的城乡社区。GHESKIO使用类似于典型的美国VA中心的综合护理模式运营，并为反映资源受限国家流行病断层线的人口提供服务：贫困和权力丧失，混乱的城市化和频繁的内乱造成的创伤和暴力以及法治不足。使用CBSM的车辆，一个潜在的有效的预防干预措施，以减少艾滋病毒感染者（PLWH）在这个临床场所之间的传播风险，提高了成功的概率。CBSM-A，适应性干预评估，是基于美国国立卫生研究院在海地的试点研究，是由信息-动机-行为（IMB）理论的指导。这是一个针对艾滋病毒+艾滋病使用人群的小组设计，也解决了他们的认知/自我管理和应对障碍，这些障碍可能阻碍可持续的成果，特别是在海地这样资源有限的环境中。HLM/SEM分析将用于探索对安全性行为和ARV用药指南的依从性，以及传统IMB变量、AOD使用和EnvPsySoc因素如何影响干预效果。拟议的项目响应美国国立卫生研究院的优先事项整合环境心理研究和临床研究和实践的桥梁，通过调整和翻译有效的研究为基础的干预策略，为“真实的世界”所面临的条件，以社区为基础的供应商。如果成功，这项研究将提出一项艾滋病毒干预战略，可以在海地和其他资源有限的环境中实际实施艾滋病毒+成人高风险行为（酒精使用和不安全的性行为），同时推进如何为这些环境量身定制干预措施的知识基础。 公共卫生相关性：拟议的研究是一项认知行为压力管理（CBSM）干预的适应和随机试验，该干预将提高安全性行为，坚持抗逆转录病毒药物治疗，并减少艾滋病毒感染者（PLWH）在海地高风险，贫困，城市中心的酒精或其他药物（AOD）使用。该研究的一个重点是艾滋病毒干预结果如何受到一系列与酒精相关的环境和心理社会（Env-Psy-Soc）因素的影响。如果成功，这项研究将提出一项艾滋病毒干预战略，可以在海地和其他资源有限的环境中为具有高风险行为（包括饮酒）的艾滋病毒阳性成年人实际实施，同时推进如何为这些环境量身定制干预措施的知识基础。

DESCRIPTION (provided by applicant): The proposed study is an adaptation and randomized trial of a Cognitive-Behavioral Stress Management (CBSM) intervention for simultaneously enhancing safer sex practices, adherence to ARV medication, and reducing alcohol or other drugs (AOD) use, in a predominantly poor urban population in Haiti. With our on- site clinical research partner, the GHESKIO Centers, a key focus will be how HIV intervention outcomes are influenced by Environmental and PsychoSocial (Env-Psy-Soc) factors. Performing this study in Haiti with GHESKIO presents a unique opportunity to contribute an EnvPsySoc dimension to the HIV/AIDS prevention and treatment scale-up that is ongoing there and in the region. GHESKIO is unique and unparalleled in Haiti and the region as a socially trusted infectious disease control institution that has been there since the discovery of the HIV virus and that has successfully adapted an academically disciplined HIV/AIDS clinical research and training model into the urban and rural communities of Haiti. GHESKIO operates using an integrated care model similar to a typical U.S. VA center, and serves a population reflective of the fault lines of the epidemic in resource-constrained countries: poverty and disempowerment, the trauma and violence of chaotic urbanization and frequent civil disorder and inadequate rule of law. Using the vehicle of CBSM, a potentially efficacious prevention intervention for reducing HIV transmission risk among People Living with HIV (PLWH) in this clinical venue enhances the probability of success. CBSM-A, the adapted intervention to be evaluated, is based on an NIH pilot study in Haiti that was guided by Information-Motivation-Behavior (IMB) theory. It is a small-group design for HIV+ AOD using populations, which also addresses their cognitive/self management and coping barriers that may impede sustainable outcomes, particularly in resource-constrained settings as Haiti. HLM/SEM analyses will be used to explore adherence to safer sex and ARV medication guidelines as well as how intervention effects are influenced by traditional IMB variables, AOD use, and EnvPsySoc factors. The proposed project responds to the NIH priority on integrating environmental-psychosocial research and on bridging clinical research and practice, by adapting and translating effective research-based intervention strategies for the "real world" conditions faced by community based providers. If successful, this research will present an HIV intervention strategy that can be practically implemented for HIV+ adults with high risk behaviors (alcohol use and unsafe sexual practices) in Haiti and other resource-constrained settings, while advancing the knowledge base of how to tailor interventions for such settings. PUBLIC HEALTH RELEVANCE: The proposed study is an adaptation and randomized trial of a Cognitive-Behavioral Stress Management (CBSM) intervention that will enhance safer sex practices, adherence to ARV medication, and reduce alcohol or other drugs (AOD) use in People Living with HIV (PLWH) in a high risk, poor, urban center in Haiti. A key focus of the study will be how HIV intervention outcomes are influenced by a set of alcohol-related Environmental and PsychoSocial (Env-Psy-Soc) factors. If successful, this research will present an HIV intervention strategy that can be practically implemented for HIV+ adults with high risk behaviors, including alcohol use, in Haiti and other resource-constrained settings, while advancing the knowledge base of how to tailor interventions for such settings.