The overall goal of this proposal is to provide the mentoring, coursework, and research experience to allow the applicant to develop into an independent investigator performing behavioral interventions in HIV+ women with co-occurring alcohol use and depression/or anxiety disorders. Alcohol, depression, and anxiety independently affect HIV disease progression. Importantly, alcohol use frequently co-occurs with depression and anxiety, particularly among women. Despite the relative frequency of co-occurrence, the impact of co-occurring alcohol use and depression/anxiety has not been evaluated among HIV+ women. The goals of this research proposal are three-fold: 1) to examine the effect of co-occurring alcohol and depression on HIV disease progression (HIV-RNA, adherence, quality of life, mortality) in HIV+ women; 2) to examine the effect of co-occurring alcohol and anxiety on HIV disease progression in HIV+ women 3) to obtain preliminary data of the effectiveness of brief alcohol interventions in HIV+ women with co-occurring disorders. Specific goals will be accomplished by building upon 2 unique resources for clinical research: a recently funded RCT of brief alcohol interventions, and the Johns Hopkins HIV Clinical Cohort, The applicant will add psychological and quality of life measures which will enable her to assess 1) the impact of co-occurring disorders on HIV related disease outcomes both cross-sectionally and longitudinally, 2) brief alcohol intervention effectiveness among women with co-occurring disorders. In addition, enhanced psychological assessment will allow the applicant to examine the role of subthreshold psychiatric symptoms in alcohol use and HIV disease progression, which have not been explored within the contexts of alcohol use or HIV disease. The skills necessary to accomplish the above goals will be obtained through 1) mentorship by experts in alcohol use disorders, HIV epidemiology and mental health 2) directed readings and seminars arid 3) coursework in mental health epidemiology, alcohol and drug use disorders, and the design and analysis of clinical trials.
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