Women focused Encounters for Resilience, Independence, Strength and Eudaimonia (WE RISE)

项目摘要 妇女是世界上艾滋病毒携带者的大多数。然而，女性在中国的代表性不足 艾滋病毒研究仍在继续，尽管他们经历了更大的社会/社会健康差距(SSDoH)，包括 与男性相比，获得艾滋病毒护理的机会和较差的艾滋病毒结果。物质的汇聚 (Ab)使用、对妇女和女孩的暴力(创伤)和艾滋病/艾滋病毒(称为Sava) 导致艾滋病毒携带者和有艾滋病毒风险的妇女与艾滋病毒相关的发病率过高。这项建议旨在 通过评估有效性和实施情况改善艾滋病毒感染妇女(WLWH)的艾滋病毒结果 针对药物使用、创伤和艾滋病毒的联合干预。 我们将采用随机化的类型1混合研究来评估接受和承诺的有效性 由同伴导航员提供的治疗、锻炼和社会支持。实施战略，承载 WLWH有可能解决SSDoH(经济不安全、医疗保健机会有限、社区有限) 将对经验进行评估，并可能加强可持续性和传播。基于社区的 四个终止艾滋病毒流行辖区的组织将总共使用48周的干预措施 每个站点。头24周(研究有效性)将包括一项对40名WLWH和Will的随机研究 评估对HIV的影响(ART依从性、持续病毒抑制率)、物质使用(天数和 使用量)、创伤(创伤症状)和所有三种情况的共同因素(情绪、社交 断开)随着时间的推移。24-48周将包括研究实施阶段，由 评估地方障碍的探索、准备、实施和维持(EPIS)框架， 促进者、为解决卫生和社会结构性/社会差距而选定的执行战略的变化 使用记录适应和修改框架的干预适应--增强 (框架)。以下目标将指导对我们的干预措施的评估，该干预措施称为以妇女为重点 为了坚韧、独立、力量和幸福而相遇(我们崛起)。 目标1：评估短期(第8周)和长期(第12、24周)WE RISE对艾滋病毒的有效性(↑ART 坚持、持续病毒抑制的参与者的↑%)、创伤(↓创伤症状)、药物使用 (↓药物使用天数)和跨诊断因素，如情绪(↓抑郁、↓焦虑)和社交 连通性。 目标2：通过描述覆盖范围、有效性、采用率、 现场实施和维护(RE-AIM)，为期24周。 目标3：在24周和48周结束时，制定替代或额外的执行战略，以 解决当地障碍并利用促进者来优化效率、维护和更广泛的 WE RISE的传播和网站特定文件的改编框架。

Project Abstract Women represent the majority of people living with HIV in the world. Yet the underrepresentation of women in HIV research persists despite them experiencing greater societal/social disparities of health (SSDoH) including HIV care access and poorer HIV outcomes when compared to men. The coming together of substance (ab)use, violence against women and girls (trauma), and AIDS/HIV (known as SAVA) in the context of SSDOH contributes to excess HIV associated morbidity in women living with and at risk for HIV. This proposal aims to improve HIV outcomes in women living with HIV (WLWH) by evaluating the effectiveness and implementation of a combination intervention addressing substance use, trauma, and HIV. We will employ a randomized Type1 Hybrid study evaluating the effectiveness of acceptance and commitment therapy, exercise, and social support delivered by peer navigators. Implementation strategies that carry the potential to address SSDoH (economic insecurity, limited healthcare access, limited community) that WLWH experience and may enhance sustainability and dissemination will be evaluated. Community-based organizations in four Ending the HIV Epidemic jurisdictions will employ the intervention for a total of 48 weeks per site. The first 24 weeks (research effectiveness) will include a randomized study of 40 WLWH and will evaluate the impact on HIV (ART adherence, % continuous viral suppression), substance use (days and amount of use), trauma (trauma symptoms) and factors common to all three conditions (mood, social disconnection) over time. Weeks 24-48 will include a research implementation phase guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) framework evaluating local barriers, facilitators, change in implementation strategies selected to address structural/social disparities of health and intervention adaptations using the the Framework for Recording Adaptations and Modifications-Enhanced (FRAME). The following aims will guide evaluation of our intervention referred to as women focused encounters for resilience, independence, strength and eudaimonia (WE RISE). Aim 1: Evaluate short (week 8) and longer term (weeks 12, 24) effectiveness of WE RISE on HIV (↑ ART adherence, ↑ % of participants with continuous viral suppression), trauma (↓ trauma symptoms), substance use (↓ days of substance use) and transdiagnostic factors such as mood (↓depression, ↓anxiety) and social connectedness. Aim 2: Document the WE RISE implementation process by characterizing reach, effectiveness, adoption, implementation and maintenance (RE-AIM) by site for 24 weeks. Aim 3: At completion of 24 and 48 weeks, transcreate alternate or additional implementation strategies that address local barriers and leverage facilitators to optimize the effectiveness, maintenance and broader dissemination of WE RISE and document site-specific adaptations FRAME.