This is a re-submission of a K23 award for Susan Meffert MD, MPH, Assistant Professor of Psychiatry at UCSF. This career award proposal builds on Dr. Meffert's research with emotionally traumatized populations in Low-and-Middle-Income Countries (LMICs) and proposes research and training goals to focus her work on HIV-infected (HIV+) women exposed to Gender-Based Violence (GBV) (HIV+GBV+). Despite knowledge that GBV has profound adverse effects on physical health (exceeding direct injury),1-4 and that GBV is highly prevalent among HIV+ women,5,6 little is known about how GBV affects HIV outcomes. In cross sectional analysis, GBV is associated with detectable viral load (VL) and decreased CD4 count.7 Mental health sequeale of GBV, including Posttraumatic Stress Disorder (PTSD) and depression, are theorized mediators of the relationships between violence, HAART adherence and poor HIV outcomes.7,8 However, without a data-driven understanding of these relationships, we are unable to develop psychiatric treatments that effectively improve the overall health of the extraordinary numbers of HIV+ women exposed to GBV. The proposal addresses this crucial knowledge gap using a large longitudinal cohort study of HIV+ women and a pilot intervention with HIV+GBV+ women in a high burden region. Mentored by internationally recognized scientists, I propose three research aims:
Aim 1 is a longitudinal analysis of GBV, HIV outcomes and mental health mediators in the largest prospective cohort study of HIV- affected women (Women's Interagency HIV Study [WIHS]). My co-mentor, Ruth Greenblatt, MD, is the N. California PI for the WIHS study. Building on my work with the UCSF-Family AIDS Care Education and Services (FACES) program in a high HIV region of Kenya, Aim 2 is an adaptation of an established mental health treatment (Interpersonal Psychotherapy [IPT]) for depression and PTSD among HIV+GBV+ women at FACES.
Aim 3 is a pilot study assessing feasibility and acceptability of the adapted IPT. UCSF-FACES is a PEPFAR-funded care and research collaboration serving more than 90,000 HIV+ individuals in western Kenya. FACES has robust research infrastructure and I have an established, highly productive research team onsite. This proposal is significant because it will generate the first longitudinal analysis of GBV, HIV outcomes and mental disorders, and the first mental health intervention adapted and piloted for HIV+GBV+ women. These studies may substantially improve women's HIV programs by addressing a largely untapped mental health pathway affecting HIV outcomes among GBV+ women and developing/piloting a psychiatric treatment for HIV+GBV+ women.
These research aims are tightly integrated with my training goals: (1) Longitudinal analytic methods in HIV; (2) IPT adaptation and (3) Mental health intervention research. These studies will generate preliminary findings for an R01-funded intervention testing the efficacy of adapted IPT for the effects of GBV on psychiatric and HIV outcomes.
The proposed research is relevant to public health because it addresses the intersection of HIV, the leading cause of death for reproductive age women, worldwide, and mental illness, the leading cause of chronic disease burden for reproductive age women in LMICs. These aims will produce the first longitudinal analysis of the relationship between GBV and HIV outcomes, as well as the first adaptation and pilot of an acceptable and feasible mental health intervention for HIV+GBV+ women in sub-Saharan Africa. The project is relevant to the missions of the NIMH and the Division of AIDS Research (DAR) because it proposes a novel psychiatric intervention to remediate the mental health and ARV adherence difficulties of HIV+ women affected by GBV in a resource-poor setting.
