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

描述（由申请人提供）：拟议的研究是一项认知行为压力管理（CBSM）干预的适应性和随机试验，旨在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，在海地主要贫穷的城市人口中。与我们的现场临床研究合作伙伴，GHESKIO中心，重点将是艾滋病毒干预结果如何受到环境和社会心理（环境-心理-社会）因素的影响。与GHESKIO一起在海地进行这项研究提供了一个独特的机会，可以为当地和该地区正在进行的艾滋病毒/艾滋病预防和治疗的扩大提供环境心理社会层面的贡献。GHESKIO在海地和本区域是独一无二的，是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，并成功地在海地城市和农村社区采用了一种学术严谨的艾滋病毒/艾滋病临床研究和培训模式。GHESKIO采用与典型的美国退伍军人服务中心类似的综合护理模式运作，服务的人群反映了资源受限国家的流行病断层线：贫困和丧失权力、混乱的城市化带来的创伤和暴力、频繁的内乱和法治不足。利用CBSM这一载体，一种潜在有效的预防干预措施可以降低HIV感染者（PLWH）在临床中的传播风险，从而提高了成功的可能性。CBSM-A，即待评估的适应性干预，是基于美国国立卫生研究院在海地进行的一项以信息-动机-行为（IMB）理论为指导的试点研究。这是一个针对艾滋病毒+ AOD使用人群的小组设计，它还解决了他们的认知/自我管理和应对可能阻碍可持续结果的障碍，特别是在海地这样资源受限的环境中。HLM/SEM分析将用于探讨安全性行为和抗逆转录病毒药物指南的依从性，以及传统IMB变量、AOD使用和EnvPsySoc因素如何影响干预效果。拟议中的项目响应了美国国立卫生研究院整合环境-社会心理研究和连接临床研究与实践的优先事项，通过适应和翻译有效的基于研究的干预策略，以适应社区提供者面临的“现实世界”条件。如果取得成功，这项研究将提出一种艾滋病毒干预策略，可以在海地和其他资源受限的环境中实际实施，用于有高风险行为（酒精使用和不安全性行为）的艾滋病毒阳性成年人，同时提高如何为此类环境量身定制干预措施的知识库。

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.