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

描述(由申请人提供)：许多美国印第安人(AI)女性从未接受过因创伤事件、暴力暴露和虐待而导致的严重精神健康问题的服务。人工智能女性患有创伤后应激障碍(PTSD)的终生比率较高(20%-23%)，通常与酗酒和危险的性行为并存。这些因素放大了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。在与部落合作伙伴的全面开发中，该应用程序响应“R34 PA-09-146：药物滥用预防试验准备中的试点和可行性研究”，提出了一个为期3年的项目，以在文化上适应和试点50名人工智能女性中以创伤为重点的治疗、认知处理疗法(CPT)对创伤后应激障碍、药物使用和艾滋病毒/性传播感染的性风险行为的经验支持。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。这个项目在侧重点和方法上都是创新的。它为研究不足和高度脆弱的人口带来了一种对文化反应的干预。它将在文化上调整和修改以循证为基础的CPT干预措施，以解决健康危险行为(物质和酒精使用以及精神障碍和高风险性行为)。它的意义在于它有可能在创伤后应激障碍、药物使用治疗和人工智能妇女中的艾滋病毒/性传播感染预防领域推进科学。研究数据将使部落和农村社区以及心理健康领域受益。最后，它的目标是发展研究基础设施和心理健康治疗能力，为生活在农村环境中的人工智能妇女服务，这是一个面临艾滋病毒/艾滋病疫情不断扩大的风险的群体。如果成功，这项试点的结果将为更大规模的有效性试验提供证据。其目标是与部落伙伴充分合作，调整循证CPT干预措施。这将根据疾控中心的适应过程地图进行，并涉及使用定性方法与部落首领、潜在消费者、提供者和卫生保健管理人员进行形成性研究。目的2.评估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地环境中的可行性和可接受性。目的3.在50名患有创伤后应激障碍或阈值以下创伤后应激障碍的性活跃和使用人工智能的女性中，进行为期12个疗程、为期3个月的CPT干预的两组、单地点等待名单随机对照先导试验。根据三个主要结果确定初步疗效并估计效果大小：(A)创伤后应激障碍症状；(B)药物使用；(C)高风险性行为。

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.