A Harm Reduction Approach to Addressing the HIV, STIs, and Substance Use Syndemic among People Engaging in Sex Work in Alabama

减少危害的方法，解决阿拉巴马州从事性工作的人群中艾滋病毒、性传播感染和药物滥用问题

• 批准号: 10814069
• 负责人: Renee A. Heffron
• 金额: $ 21.36万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-03-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10814069
• 关键词: AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Alabama; Award; Awareness; Black Populations; COVID-19 pandemic; Cessation of life; Characteristics; Clinical; Clinical Trials; Communities; Consolidated Framework for Implementation Research; Data; Deep South; Development; Drug usage; Drug user; Epidemic; Evidence based intervention; Face; Food; Funding; HIV; HIV Infections; HIV diagnosis; HIV/STD; Harm Reduction; Health; Health Resources; Healthcare; Hepatitis C virus; Housing; Incidence; Individual; Injecting drug user; Intervention; Interview; Measures; Methods; Outcome; Overdose; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Process; Provider; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Resources; Risk; Risk Reduction; Rural; Services; Sterility; Structure; Surveys; Syringes; Target Populations; Testing; Underserved Population; United States; Vulnerable Populations; Work; clinical outcome assessment; condoms; evidence base; follow-up; health equity; implementation framework; implementation outcomes; informant; insight; novel; outreach; parent grant; pre-exposure prophylaxis; prescription opioid; preventive intervention; response; risk perception; role model; sex; social stigma; socioeconomic disparity; substance use; syndemic; systematic review; testing access; theories; tool; uptake; AIDS prevention; Acquired Immunodeficiency Syndrome; Address; Alabama; Award; Awareness; Black Populations; COVID-19 pandemic; Cessation of life; Characteristics; Clinical; Clinical Trials; Communities; Consolidated Framework for Implementation Research; Data; Deep South; Development; Drug usage; Drug user; Epidemic; Evidence based intervention; Face; Food; Funding; HIV; HIV Infections; HIV diagnosis; HIV/STD; Harm Reduction; Health; Health Resources; Healthcare; Hepatitis C virus; Housing; Incidence; Individual; Injecting drug user; Intervention; Interview; Measures; Methods; Outcome; Overdose; Participant; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Prevention; Process; Provider; Qualitative Research; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Reporting; Research; Resources; Risk; Risk Reduction; Rural; Services; Sterility; Structure; Surveys; Syringes; Target Populations; Testing; Underserved Population; United States; Vulnerable Populations; Work; clinical outcome assessment; condoms; evidence base; follow-up; health equity; implementation framework; implementation outcomes; informant; insight; novel; outreach; parent grant; pre-exposure prophylaxis; prescription opioid; preventive intervention; response; risk perception; role model; sex; social stigma; socioeconomic disparity; substance use; syndemic; systematic review; testing access; theories; tool; uptake

PROJECT SUMMARY Despite the availability of biomedical prevention tools to end the HIV epidemic, incidence of HIV and other STIs in Alabama remain high, while uptake of prevention such as PrEP remains low. Further, opioid prescribing, use, and overdose-related death are also disproportionately high in Alabama, with an increasing impact on Black individuals. Converging risk related to HIV, STIs, and drug use can be attributed in part to socioeconomic inequalities in the Deep South which may drive sex work. Recent evidence suggests individuals engaged in sex work report higher rates of diverse drug use and increased vulnerability to HIV and other STIs compared to other individuals in Alabama. Sex workers and people who use drugs represent vulnerable groups who face unique barriers to HIV prevention including PrEP. However, HIV services for sex workers in Alabama are limited, and no evidence-based interventions in the CDC’s Compendium have been tailored for sex workers. Through community-academic partnership, this project will use syndemic theory to directly address the needs of a severely underserved population through development of a PrEP intervention for people engaging in sex work in Alabama. The Specific Aims are to: (1) Develop a harm reduction intervention that responds to syndemic drug use, HIV, and STIs for people engaged in sex work, [Year 1] and (2) Pilot and evaluate the acceptability, appropriateness, and feasibility of the intervention to increase PrEP uptake among people engaged in sex work [Year 2]. Within Aim 1, we will leverage existing quantitative data to identify intervenable Outer Setting characteristics (patient needs and resources) and collect de novo qualitative data to further characterize sex work, contextualize the needs and resources of individuals engaged in sex work, and characterize the processes and resources of Birmingham AIDS Outreach (BAO) to inform intervention approaches. Under Aim 2, pending CFAR renewal, we will pilot the intervention at BAO with 40 individuals engaging in sex work, and will evaluate the intervention’s acceptability, appropriateness, and feasibility from a participant and provider perspective. We will assess clinical outcomes and preliminary effects on PrEP use and uptake of harm reduction strategies (use of condoms and sterile syringes). This work will be guided by the Consolidated Framework for Implementation Research (CFIR), RE-AIM framework, and ERIC strategies. The project will result in formation of a Health Equity Research Assembly, development of a novel harm reduction intervention for people engaged in sex work, and, if Year 2 is awarded, pilot data to inform a subsequent R- level proposal.

项目摘要 尽管生物医学预防工具可用来终止艾滋病毒流行病，但艾滋病毒和其他性传播感染的事件 在阿拉巴马州仍然很高，而诸如PREP等预防的吸收仍然很低。此外，阿片类药物处方， 在阿拉巴马州的使用和过量相关的死亡也不成比例 黑人。与艾滋病毒，性传播感染和吸毒有关的风险融合可以部分归因于社会经济 深南部的不平等可能会推动性工作。最近的证据表明个人参与 性工作报告说，与艾滋病毒和其他性传播感染的潜水员使用率更高，与 阿拉巴马州的其他人。性工作者和使用毒品的人代表面对的弱势群体 预防艾滋病毒的独特障碍，包括准备。但是，阿拉巴马州的性工作者的艾滋病毒服务是 有限的，没有针对性工作者量身定制的CDC纲要中的循证干预措施。 通过社区学术伙伴关系，该项目将使用辛迪克利亚理论直接满足需求 通过开发从事性行为的人的准备干预措施，严重服务不足的人群 在阿拉巴马州工作。具体目的是：（1）制定减少危害的干预措施 用于从事性工作的人的辛迪克药物使用，艾滋病毒和性传播疾病，[1年]和（2）试行并评估 干预措施的可接受性，适当性和可行性增加了人们的准备 从事性工作[2年]。在AIM 1中，我们将利用现有的定量数据来识别可干预 外部设置特征（患者需求和资源）并收集从头定性数据以进一步 描述性工作，背景化从事性工作的个人的需求和资源，以及 描述伯明翰艾滋病外展（BAO）的过程和资源以告知干预 方法。在AIM 2下，在CFAR续订之前，我们将与40个人一起在BAO进行干预 从事性工作，并将评估干预措施的可接受性，适当性和可行性 参与者和提供者的观点。我们将评估对PrEP使用的临床结果和初步影响 采取减少损害策略（使用避孕套和无菌注射器）。这项工作将由 合并实施研究框架（CFIR），RE-AIM框架和ERIC策略。这 项目将导致卫生公平研究大会的形成，发展新型伤害 干预从事性工作的人，如果授予了2年级的驾驶数据，以告知随后的R- 级别的建议。