Implementation Research for Vulnerable Women in South Africa

南非弱势妇女实施研究

• 批准号: 8866339
• 负责人: WENDEE M WECHSBERG
• 金额: $ 61.15万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 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/8866339
• 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; 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' 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; methamphetamine use; outreach; pregnant; satisfaction; scale up; sex; substance abuse treatment; substance abuser; success; therapy adherence; transmission process; treatment as usual; uptake; violence prevention

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）：最近估计南非妇女中的艾滋病毒感染率超过 40%。在南非，感染艾滋病毒或有感染艾滋病毒风险的弱势妇女因性别暴力 (GBV) 以及酗酒和其他药物 (AOD) 的使用而面临保护自己的障碍。 AOD 的使用降低了接受检测的人进行 HIV 检测和接受抗逆转录病毒治疗 (ART) 的可能性，并降低了接受 ART 的人的依从性。 AOD 的使用还会增加可能传播 HIV 的行为。尽管使用 AOD 对感染艾滋病毒的妇女产生了普遍的负面影响，但很少有提供艾滋病毒咨询和检测 (HCT) 或产前护理的卫生诊所、药物滥用康复诊所或艾滋病毒临床护理使用循证干预措施 (EBI) 来解决这个问题。自 2001 年以来，我们针对女性调整并实施了一项全面的 EBI，即女性健康合作社 (WHC)，该计划旨在解决酒精 AOD 的使用、性风险和 GBV 问题。它纳入了个性化的行动计划，并与抗逆转录病毒疗法、药物滥用治疗或住房等其他环境需求等卫生服务联系起来。 WHC 被列入美国国际开发署非洲性别研究纲要。我们将这一干预措施打包用于培训培训师，并准备将其纳入日常护理中，以帮助解决弱势妇女面临的许多问题。因此，我们的建议是确保其成功之前的下一个合乎逻辑的步骤，然后才能进行更大规模的推广。该提议的 R01 项目旨在开发和测试集成 EBI 的实施策略。我们将采用形成性方法与社区妇女、我们的社区咨询委员会、诊所工作人员和管理人员合作，制定和实施一项营销计划，以解决将 WHC 纳入提供产前或 HCT 服务的常规护理保健中心的挑战。药物滥用康复中心（康复中心）。形成性工作的结果将指导一系列迭代试点研究的实施，使用阶梯楔形设计来评估实施和患者结果。 具体目标：我们的具体目标包括以下内容： 目标 1. 制定、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中心以实施 WHC。目标 2. 通过跨健康和康复诊所的阶梯式楔形设计提供 WHC，以评估实施情况（可接受性、采用性、成本、保真度、渗透性和可持续性）和服务成果（全面的服务和及时的服务联系）。目标 3. 在 6 个月的随访中评估 WHC 患者的结果（有效性、满意度）。在常规护理环境中实施 EBI，以惠及更多使用 AOD 的 HIV 阳性女性，如果能够成功实施并在现实环境中被证明是有效和可持续的，那么它可能会对公共卫生产生重大影响。