Implementation Research for Vulnerable Women in South Africa

南非弱势妇女实施研究

基本信息

批准号：
8666443
负责人：
WENDEE M WECHSBERG
金额：
$ 67.95万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-06-10 至 2019-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8666443
关键词：
Address Adherence Administrator Adoption Africa Alcohol abuse Alcohol or Other Drugs use Alcohols Behavior Caring Case Management Centers for Disease Control and Prevention (U.S.)Clinic Clinical Communication Communities Counseling Couples Data Disadvantaged Distal Drug usage Educational Intervention Effectiveness Enrollment Ensure Evidence based intervention Face Female Gender Gender Role Goals HIV HIV Seropositivity Health Health Services Hepatitis B Virus Hepatitis C virus Heterosexuals Housing Human immunodeficiency virus test Individual Intervention Letters Life Link Marketing Measures Mediation Methamphetamine Methods Modeling Names Outcome Patients Penetration Pilot Projects Prevalence Procedures Process Province Public Health Rehabilitation Centers Rehabilitation therapy Risk Series Services Site South Africa Substance abuse problem Testing Time Trainers Training Translating Tuberculosis USAID United States Ursidae Family Violence Vulnerable Populations Woman Women&apos s Health Work alcohol and other drug alcohol risk reduction antiretroviral therapy base clinical care cost design disorder prevention drug abuser empowerment flexibility follow-up implementation research implementation science improved medication compliance outreach pregnant public health relevance satisfaction scale up sex substance abuse treatment substance abuser success therapy adherence transmission process treatment as usual uptake violence prevention

项目摘要

DESCRIPTION (provided by applicant): Recent estimates of HIV prevalence among women in South Africa exceed 40%. Vulnerable women living with HIV or at risk of HIV in South Africa face barriers to protecting themselves because of gender-based violence (GBV) and alcohol and other drug (AOD) use. AOD use reduces the likelihood of testing for HIV and access to antiretroviral therapy (ART) among those who are tested and reduces adherence among those who are on ART. AOD use also increases behaviors that may transmit HIV. Despite the pervasive negative impact of AOD use among women living with HIV, very few health clinics that provide HIV counseling and testing (HCT) or antenatal care, substance abuse rehabilitation clinics, or HIV clinical care use evidence- based interventions (EBIs) to address this problem. Since 2001, we have adapted and conducted a comprehensive EBI for women, the Women's Health CoOp (WHC), that addresses alcohol AOD use, sexual risk, and GBV. It incorporates a personalized action plan complete with linkages for health services like ART, substance abuse treatment, or other environmental needs such as housing. The WHC was listed in the USAID Compendium of Gender Studies in Africa. We packaged this intervention for training of trainers and it is poised to be integrated into usual care to help address many of the issues facing vulnerable women. Consequently, our proposal is the next logical step to ensure its success before a larger scale-up can occur. This proposed R01 project seeks to develop and test an implementation strategy for integrating an EBI. We will use formative methods to collaborate with community women, our Community Advisory Boards, clinic staff, and administrators to develop and implement a marketing plan that addresses the challenges of integrating the WHC into usual care health centers where antenatal or HCT services are provided and into substance abuse rehabilitation centers (rehab). The findings from the formative work will guide the implementation in a series of iterative pilot studies using a stepped-wedge design to evaluate the implementation and patient outcomes. Specific Aims: Our specific aims include the following: Aim 1. Develop, implement, and assess the appropriateness of a marketing plan to facilitate entry into health centers and rehab sites for the implementation of the WHC. Aim 2. Deliver the WHC via a stepped-wedge design across health and rehab clinics to evaluate implementation (acceptability, adoption, cost, fidelity, penetration, and sustainability) and service outcomes (comprehensive services and timely service linkages). Aim 3. Assess WHC patient outcomes (effectiveness, satisfaction) at 6-month follow-up. Implementing an EBI in usual care settings to reach more vulnerable AOD-using women who are HIV+ has potentially high public health impact if it can be implemented successfully and shown to be effective and sustainable in real-world settings.

描述（由申请人提供）：南非妇女艾滋病毒患病率的最新估计超过40％。由于基于性别的暴力（GBV），酒精和其他药物（AOD）使用，南非有艾滋病毒或艾滋病毒危险的脆弱妇女面临保护自己的障碍。 AOD的使用降低了对艾滋病毒的检测可能性和接受抗逆转录病毒疗法（ART）的可能性，在接受测试的患者中，在那些正在接受艺术的人中的依从性。 AOD的使用还增加了可能传播HIV的行为。尽管AOD在艾滋病毒妇女中使用AOD的普遍负面影响，但很少有提供HIV咨询和测试（HCT）或产前护理的健康诊所，药物滥用康复诊所或HIV临床护理使用基于证据的干预措施（EBIS）来解决此问题。自2001年以来，我们为妇女（WHC）（WHC）改编并进行了全面的EBI，该妇女涉及酒精AOD的使用，性风险和GBV。它结合了一个个性化的行动计划，并附有卫生服务的联系，例如艺术，滥用药物治疗或其他环境需求，例如住房。 WHC被列为非洲性别研究的USAID纲要。我们将这种干预措施打包给培训培训师，并准备将其纳入通常的护理中，以帮助解决弱势妇女面临的许多问题。因此，我们的建议是确保在大规模扩大之前确保其成功的下一个逻辑步骤。该提议的R01项目旨在制定和测试整合EBI的实施策略。我们将使用形成性方法与社区妇女，我们的社区咨询委员会，诊所员工和管理人员合作制定和实施营销计划，以解决将WHC整合到通常提供产前或HCT服务以及提供产前或HCT服务的挑战中，并提供滥用药物滥用中心（REAB）。形成性工作的发现将在一系列迭代试点研究中指导实施，使用阶梯式设计设计来评估实施和患者的结果。具体目的：我们的具体目的包括以下内容：目标1。开发，实施和评估营销计划的适当性，以促进进入卫生中心和康复地点以实施WHC。 AIM 2。通过跨健康和康复诊所的阶梯式设计来交付WHC，以评估实施（可接受性，采用，成本，忠诚度，渗透率和可持续性）和服务成果（综合服务和及时的服务联系）。目标3。在6个月的随访中评估患者的结果（有效性，满意度）。在通常的护理环境中实施EBI，以达到更脆弱的AOD妇女，而艾滋病毒+的妇女可能会成功实施，并在现实环境中实施有效和可持续性。