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.
|Thangavel, Samikkannu; Mulet, Carmen T; Atluri, Venkata S R et al. (2018) Oxidative Stress in HIV Infection and Alcohol Use: Role of Redox Signals in Modulation of Lipid Rafts and ATP-Binding Cassette Transporters. Antioxid Redox Signal 28:324-337|
|Dévieux, Jessy G; Jean-Gilles, Michèle; Frankel, Anne et al. (2016) Predictors of Sexual Activity in Haitian-American Adolescents. J Immigr Minor Health 18:161-72|
|Dévieux, Jessy G; Rosenberg, Rhonda; Saint-Jean, Gilbert et al. (2015) The Continuing Challenge of Reducing HIV Risk among Haitian Youth: The Need for Intervention. J Int Assoc Provid AIDS Care 14:217-23|
|Agudelo, Marisela; Khatavkar, Pradnya; Yndart, Adriana et al. (2014) Alcohol abuse and HIV infection: role of DRD2. Curr HIV Res 12:234-42|
|Conserve, Donaldson F; King, Gary; Dévieux, Jessy G et al. (2014) Determinants of HIV serostatus disclosure to sexual partner among HIV-positive alcohol users in Haiti. AIDS Behav 18:1037-45|
|Malow, Robert; Dévieux, Jessy G; Stein, Judith A et al. (2013) Depression, substance abuse and other contextual predictors of adherence to antiretroviral therapy (ART) among Haitians. AIDS Behav 17:1221-30|
|Devieux, Jessy G; Malow, Robert M; Attonito, Jennifer M et al. (2013) Post-traumatic stress disorder symptomatology and alcohol use among HIV-seropositive adults in Haiti. AIDS Care 25:1210-8|
|Malow, Robert M; Dévieux, Jessy G; Stein, Judith A et al. (2012) Neurological function, information-motivation-behavioral skills factors, and risk behaviors among HIV-positive alcohol users. AIDS Behav 16:2297-308|
|Malow, Robert; Rosenberg, Rhonda; Lichtenstein, Bronwen et al. (2010) The impact of disaster on HIV in Haiti and priority areas related to the Haitian crisis. J Assoc Nurses AIDS Care 21:283-8|