Using CBPR to Engage Hazardous Drinking Women in the HIV Prevention and Care Continuum

利用 CBPR 让危险饮酒女性参与艾滋病毒预防和护理连续体

• 批准号: 9768880
• 负责人: GEETANJALI CHANDER
• 金额: $ 19.42万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768880
• 关键词: AIDS prevention; Address; Adherence; African American; Alcohol consumption; Alcohol or Other Drugs use; Alcohols; Anal Sex; Baltimore; Behavioral; Caring; Clinical Services; Collaborations; Communities; Comorbidity; Computers; Continuity of Patient Care; Development; Effectiveness; Evidence based intervention; Feedback; Female; Focus Groups; Gap Junctions; Goals; Grant; HIV; HIV Infections; HIV diagnosis; HIV risk; Health; Heavy Drinking; High Prevalence; High Risk Woman; Human immunodeficiency virus test; Individual; Interruption; Intervention; Knowledge; Manuals; Maryland; Mental Depression; Mental Health; Modification; Motivation; Outcome; Patients; Persons; Population; Preparation; Prevalence; Randomized Controlled Trials; Resources; Risk; Risk Behaviors; Risk Reduction; Sample Size; Services; Site; Stress; Structure; System; Testing; Text; Text Messaging; Time; Trauma; Treatment outcome; United States; Vagina; Washington; Woman; Work; alcohol abuse therapy; alcohol intervention; alcohol misuse; alcohol prevention; antiretroviral therapy; base; binge drinking; brief alcohol intervention; brief intervention; community based participatory research; community organizations; community partnership; condoms; drinking; effective intervention; evidence base; hazardous drinking; health disparity; implementation strategy; improved; peer; pre-exposure prophylaxis; prevention service; primary outcome; recruit; reduced alcohol use; retention rate; service providers; sex; sexual risk behavior; theories; uptake

Women account for 1 in 4 people living with HIV (PLWH) in the United States, and while African American (AA) women comprise only 14% of the US female population, they account for greater than 60% of women living with HIV (WLWH). In 2013, the state of Maryland was second only to Washington, DC in the rates of HIV diagnoses among women. Alcohol misuse interrupts critical steps in the HIV prevention and care continuum (HPACC) and thus contributes to significant health disparities among at-risk and WLWH. Our prior work in Baltimore has demonstrated a strong association between alcohol misuse and HIV risk behaviors among at risk and WLWH, poorer retention in HIV care and lower use of and adherence to antiretroviral therapy (ART). We have developed theory-based, in-person and computer-delivered brief interventions (CBI) for at risk and WLWH with alcohol misuse, demonstrating drinking reductions in recent RCTs. However behavioral and structural barriers to optimal uptake of alcohol interventions and engagement in the HPACC remain, including mental health comorbidity and low knowledge, access, and use of HIV prevention practices such as HIV pre- exposure prophylaxis (PrEP). Engaging key stakeholders, including at-risk and WLWH, and community organizations and leaders, is critical to successful implementation of interventions at the intersection of HIV and alcohol misuse among women. The goals of this proposal are two-fold: 1) to build on our current community partnerships to determine how to optimally implement evidence based alcohol treatment for at risk and WLWH in Baltimore, and 2) to determine whether the addition of information, motivational and peer navigator support related to comorbid mental health, and HIV prevention practices can enhance CBI and improve alcohol and HPACC outcomes among at risk and WLWH. To achieve these goals we will use a Community Based Participatory Research (CBPR) approach, engaging patient and community stakeholders during all aspects of study development, and community pilot testing. In collaboration with our Community Advisory Board (CAB), we will: 1) adapt our current CBI with text messaging to address gaps in the HIV prevention and care continuum (CBI-CC). We will conduct focus groups with both at risk and WLWH to tailor intervention manuals, followed by piloting and further feedback and modification. 2) We will conduct a pilot randomized controlled trial (RCT) of CBI-CC + text and peer navigation among 60 at-risk or WLWH with alcohol misuse. Primary outcomes, assessed at 3 and 6 months, include drinking days, heavy drinking days, drinks per drinking day; other outcomes include days of sex without condom use, mental health and substance use treatment engagement, and uptake of HIV prevention practices (HIV testing, PrEP, condoms).Through this U34 planning grant we will partner with key stakeholders in the community to build capacity to deliver effective, evidence-based interventions at the nexus of alcohol and HIV for at risk and WLWH with alcohol misuse, and improve engagement in the HIV prevention and care continuum.

在美国，四分之一的艾滋病毒感染者 (PLWH) 是女性，而非洲裔美国人 (AA) 女性仅占美国女性人口的 14%，但她们却占全球女性人口的 60% 以上 患有艾滋病毒（WLWH）。 2013年，马里兰州的艾滋病毒感染率仅次于华盛顿特区 女性中的诊断。酒精滥用中断了艾滋病毒预防和护理连续性的关键步骤 (HPACC)，从而导致高危人群和 WLWH 之间存在显着的健康差异。我们之前的工作 巴尔的摩已经证明，酒精滥用与艾滋病毒危险行为之间存在密切关联。 风险和 WLWH、HIV 护理保留率较差以及抗逆转录病毒治疗 (ART) 的使用和依从性较低。 我们针对高危人群开发了基于理论、面对面和计算机提供的简短干预措施 (CBI) WLWH 与酒精滥用有关，在最近的随机对照试验中证明了饮酒量的减少。然而行为和 最佳地采用酒精干预措施和参与 HPACC 的结构性障碍仍然存在，包括 心理健康合并症以及对艾滋病毒预防措施（如艾滋病毒预防措施）的了解、获取和使用程度较低 暴露预防（PrEP）。让主要利益相关者（包括高危人群、WLWH 和社区）参与进来 组织和领导人，对于成功实施艾滋病毒交叉口干预措施至关重要 以及妇女滥用酒精。该提案的目标有两个：1）以我们当前的 社区伙伴关系，以确定如何以最佳方式对高危人群实施基于证据的酒精治疗 和巴尔的摩的 WLWH，以及 2) 确定是否添加了信息、动机和同伴信息 与共病心理健康和艾滋病毒预防实践相关的导航支持可以增强 CBI 和 改善高危人群和 WLWH 的饮酒和 HPACC 结果。为了实现这些目标，我们将使用 基于社区的参与式研究 (CBPR) 方法，让患者和社区利益相关者参与 在研究开发和社区试点测试的各个方面。与我们的社区合作 咨询委员会 (CAB)，我们将： 1) 通过短信调整我们当前的 CBI，以解决艾滋病毒方面的差距 预防和护理连续体（CBI-CC）。我们将针对高危人群和 WLWH 开展焦点小组讨论，以量身定制 干预手册，然后是试点以及进一步的反馈和修改。 2）我们将进行试点 在 60 名有风险或 WLWH 中进行的 CBI-CC + 文本和同伴导航的随机对照试验 (RCT) 酒精滥用。主要结局在 3 个月和 6 个月时评估，包括饮酒天数、酗酒天数、 每个饮酒日的饮酒量；其他结果包括不使用安全套的性行为天数、心理健康和物质 使用治疗参与，并采取艾滋病毒预防措施（艾滋病毒检测、PrEP、安全套）。通过 这笔 U34 规划赠款，我们将与社区中的主要利益相关者合作，建立交付能力 针对酒精和艾滋病毒之间的关系，对酒精高危人群和低寿命妇女采取有效的、基于证据的干预措施 滥用，并提高对艾滋病毒预防和护理连续性的参与。