Adult Women Living With HIV/AIDS, Intimate Partner Violence
Conditions
Keywords
Women's Health, HIV, Intimate Partner Violence, AIDS
Brief summary
Women living with HIV/AIDS (WLWHA) in Baltimore experience disproportionately high rates of intimate partner violence (IPV), housing instability, and food insecurity, which adversely affect health outcomes. The Bartlett Bridges study is being implemented in partnership with the John G. Bartlett Infectious Diseases Specialty Practice (Bartlett Clinic) located at Johns Hopkins Hospital. The Bartlett Clinic provides comprehensive, compassionate and equitable services for infectious disease prevention, diagnosis and care. The study team will adapt and evaluate a trauma and violence-informed care (TVIC) intervention, called Confidentiality, Universal Education and Empowerment and Support (CUES), enhanced with the evidence-based myPlan safety planning app in the Bartlett Clinic to address IPV, health and safety in partnership with community organizations that provide advocacy, housing and social services. This hybrid effectiveness-implementation trial aims to improve HIV and mental health outcomes, increase safety, reduce health disparities, and identify implementation mechanisms to inform future scale-up and sustainability of the intervention in healthcare settings.
Detailed description
Objectives Aim 1: Using the ADAPT-ITT framework, the clinic-community partners will collaboratively adapt/design the CUES intervention enhanced with myPlan and connections to community organizations (CUES+) to meet the complex health and safety needs of abused WLWHA. The Hopkins team and members of the investigator's clinic-community advisory board (CAB) will collaborate to adapt and design the CUES+ intervention. Aim 2: Examine the effectiveness of the CUES+ intervention in reducing health disparities for abused WLWHA. All WLWHA clients will receive CUES+ through the clinic-community partnership. Primary outcomes (ART adherence, missed visits/proportion of visits missed, treatment adherence self-efficacy) and mental health (depression, PTSD) will be measured at baseline, 6-, and 12-months post baseline. The investigators hypothesize IPV(+) WLWHA will have poorer outcomes than IPV(-) WLWHA at baseline. After the CUES+ intervention, outcomes for IPV(+) WLWHA will approach the level of outcomes for IPV(-) WLWHA. Aim 3: Assess the mechanisms, facilitators, and barriers to implementation of clinic-community CUES+ intervention. Aim 3a: Mechanisms (e.g., safety behaviors/resources, IPV exposure, housing stability, food security) by which CUES+ intervention improves primary outcomes will be examined. The investigators hypothesize the intervention will increase safety behaviors and resources, housing stability and food security and reduce IPV exposure resulting in improvements in primary health outcomes. An understanding of mechanisms will identify clinic-community organizational culture, resources and policies needed to sustain the partnership. Aim 3b: Examine clinic-community-based partners contextual and program factors that facilitate the intervention and are needed to sustain the partnerships. The investigators will also examine barriers and facilitators to the intervention from the perspectives of clinicians and community-based partners to inform future implementation and scale-up.
Interventions
None listed
Sponsors
Johns Hopkins University
National Institute of Nursing Research (NINR)
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Hopkins Bartlett Clinic patient * HIV/AIDS positive * Self-identify as female * Adult (18 years of age or older)
Exclusion criteria
* Not a Hopkins Bartlett Clinic patient * HIV/AIDS negative * Does not identify as female * Under age of 18 years of age * Unable to provide informed consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Depression as assessed by the PROMIS Depression scale | Baseline, 6 and 12 months post baseline | PROMIS Depression 8. Score range 0 to 32; higher score is worse |
| HIV-related viral load | 12 months post baseline | Obtained from Medical Record. Score range 0-\>100,000; higher scores are worse |
| PTSD Checklist (PCL-6) | Baseline, 6 and 12 months post-baseline | PCL-6 - 6 items. Score range: 0-24; higher score is worse |
| Retrospective HIV adherence | Baseline, 6 and 12 months post-baseline | Retrospective Adherence 5-items. Score range 0-15; higher score is worse |
| HIV Adherence Self-Efficacy | Baseline, 6 and 12 months post-baseline | HIV Adherence Self-Efficacy Scale 13-items. Score range 0-39; higher score is better |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Safety Behaviors survey | Baseline, 6 and 12 months post-baseline | Safety Behaviors survey adapted from previous studies. 28 items, Score range 0-28; higher is better. |
| Intimate partner violence (IPV) as assessed by the Composite Abuse Scale | Baseline, 6 and 12 months post-baseline | Composite Abuse Scale (CASr-SF). 15 items, Score range 0-75; higher is worse |
| Housing Stability as assessed by the Homelessness Screening Clinical Reminder | Baseline, 6 and 12 months post-baseline | Homelessness Screening Clinical Reminder (HSCR). 10 items, Score range 0-10; higher score is worse |
| Food security as assessed by the Food Security in the US Survey | Baseline, 6 and 12 months post-baseline | USDA measure. 8 items. score range: 0 to 16; higher score is worse |
| Housing Conditions as assessed by the Property Condition Assessment | Baseline, 6 and 12 months post-baseline | HUD definitions, Property Condition Assessment. 2 items, score range 0 to 8; higher score is worse |
| Suicide Behavior | Baseline, 6 and 12 months post-baseline | Ideation and attempts. 2 items, score range 0-2; higher score is worse |
| Health and Well-being as assessed by the PROMIS Global Health Scale | Baseline, 6 and 12 months post baseline | PROMIS Global Health Scale. 10 items, score range 4-20; higher score is better |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORNancy Glass
Johns Hopkins School of Nursing
Outcome results
None listed