Defining intervention targets along pathways from cumulative stress and trauma to alcohol and HIV self-management among young people living with HIV (Project DEFINE)

Young people living with HIV (YPLWH) are at high risk for poor HIV self-management, with detectable viral load in 88%, and for hazardous alcohol use which can negatively impact the HIV treatment and prevention cascade. Interventions to improve self-management of both alcohol use and HIV care are critical but have had limited success in part due to the failure to account for developmental characteristics unique to this population and stress and trauma conferred by these characteristics. YPLWH experience higher rates of chronic and complex sources of stress and trauma throughout their lives. Although stress has been linked to alcohol use and disease management, the pathways underlying these links among YPLWH are poorly understood. Evidence suggests several modifiable factors that may play a role in these indirect pathways. Stress has been associated with poor sleep health, which may impact alcohol use and HIV self-management through the effect that poor sleep has on emotion regulation. Behavioral regulation (e.g., decision-making, inhibitory control), is a core component of self-management and may similarly mediate associations between cumulative stress and alcohol use. Consistent with the overall goal of the P01 to improve self-management of alcohol use and HIV care among YPLWH, this project would define developmentally relevant, modifiable intervention targets in causal pathways between cumulative stress and self-management outcomes among YPLWH, most of whom are subject to sources of stress and trauma. Using innovative outreach methods, we will enroll 300 YPLWH age 18-29 to complete surveys of cumulative and intercurrent stress and trauma, sleep health (i.e., survey and ecological momentary analysis [EMA] using an electronic sleep diary), emotion and behavioral regulation, and substance use and HIV outcomes at baseline, 9 and 18 months.