Resubmission: Multilevel Strategies & Tailored HIV Prevention & Care for Young Couples who use Alcohol & Other Drugs Across Cape Town

重新提交：多层次策略

• 批准号: 10625986
• 负责人: Felicia Amira Browne
• 金额: $ 68.05万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10625986
• 关键词: AIDS prevention; Address; Adherence; Age; Age Years; Alcohol consumption; Attitude; Behavior; Behavior Therapy; Caring; Catchment Area; Clinic; Cluster randomized trial; Communication; Communities; Continuity of Patient Care; Couples; Discrimination; Drug usage; Ensure; Epidemic; Fright; Gender; Gender Role; Goals; Government; HIV; HIV Infections; Health; Health Policy; Health Services Accessibility; Heterosexuals; Human immunodeficiency virus test; Impairment; Incidence; Individual; Intervention; Knowledge; Learning; Longevity; Mediation; Methods; National Institute of Drug Abuse; Oral; Outcome; Persons; Pharmaceutical Preparations; Phase; Prevalence; Prevention; Public Health; Randomized; Reporting; Reproductive Health Services; Risk; Risk Behaviors; Service provision; Services; Sexual Health; Sexual Partners; South Africa; Staff Attitudes; Stigmatization; Testing; Training; United States; Unsafe Sex; Viremia; Virus; Woman; aged; alcohol and other drug; antiretroviral therapy; biobehavior; burden of illness; condoms; critical period; design; economic disparity; effective intervention; efficacy testing; empowerment; evidence base; frontier; gender-based violence; improved; male; neighborhood disadvantage; novel strategies; peer; pre-exposure prophylaxis; prevent; programs; sex risk; sexual risk behavior; sexually active; skills; social stigma; syndemic; testing services; transmission process; treatment as prevention; uptake; young adult; young woman

PROJECT SUMMARY/ABSTRACT The highest HIV incidence in South Africa is among young women, many of whom are in relationships with a primary partner in which alcohol and other drug (AOD) use is common between them, in addition to condomless sex, outside sex partners, and gender-based violence (GBV). Many young women and their partners are in young adulthood, a critical period characterized by sexual risk. The proposed revised comprehensive prevention and treatment approach is needed to address these intersectional epidemics. We propose to modify our evidence-based couples' intervention for young couples in Cape Town. The proposed Couples' Health CoOp Plus (CHC+) biobehavioral intervention will include information about and linkage to PrEP and ART. We also will refine a stigma-reduction training for clinics to address stigmatizing attitudes and behaviors toward young people who use AODs and seek HIV services. We propose a multilevel approach through a cluster randomized trial with a modified factorial design whereby 24 clinics are randomized to receive either stigma-reduction training or no training. From the clinic catchment areas in economically disadvantaged communities, we will use NIDA's Seek, Test, Treat and Retain paradigm to seek 480 couples (aged 18 to 30). Clinics in catchment areas will be randomized to receive HIV testing services (HTS) and/or the CHC+. An earlier study demonstrated the efficacy of the couples' intervention on AOD use, sex risk, gender roles and HIV incidence, but it did not incorporate ART and PrEP (treat); nor was it integrated into clinics to address stigma in service provision (treat and retain). The Specific Aims are: Aim 1. To modify the CHC intervention to include ART/PrEP in a formative phase and with review from our Community Collaborative Board and a Peer Advisory Board. Aim 2. To evaluate the impact of a stigma-reduction training on clinic staffs' attitudes and behaviors toward young women and their primary male partner seeking HIV services (testing/ART/PrEP) and other sexual and reproductive health services with clinic staff at 6 and 12 months. Aim 3. To test the efficacy of the CHC+ to increase both partners' PrEP/ART initiation and adherence (at 3, 6, 9, and 12 months), and reduce AOD use, sexual risk and GBV, and enhance positive gender norms and communication relative to HTS (at 6 and 12 months). Aim 4. To examine through mixed methods the interaction of the stigma-reduction training and the CHC+ on increased PrEP and ART initiation, retention, and adherence among young women and their primary partners. If this multilevel approach demonstrates efficacy in increasing PrEP and ART initiation, adherence and retention, it could help achieve the Undetectable=Untransmittable (U=U) goals. If successful, the project could help the governments of South Africa and the United States identify new approaches to expanding the HIV continuum of prevention and care among young couples at risk for HIV.

项目摘要/摘要 南非最高的艾滋病毒发病率是年轻女性，其中许多人与 在其中，酒精和其他药物（AOD）使用的主要伴侣之间很常见 无避孕套的性爱，外部性伴侣和基于性别的暴力（GBV）。许多年轻女性及其 伴侣在成年期，一个以性风险为特征的关键时期。拟议的修订 需要全面的预防和治疗方法来解决这些相交的流行病。我们 建议修改我们基于证据的夫妇在开普敦对年轻夫妇的干预。 拟议的夫妇的健康库Plus（CHC+）生物行为干预将包括有关 与准备和艺术的联系。我们还将完善诊所的污名培训，以解决 对使用AOD并寻求艾滋病毒服务的年轻人的态度和行为的污名化和行为。我们 通过群集随机试验提出多级方法，并具有修改后的阶乘设计，其中24 诊所被随机分配以接受污名培训或没有培训。从诊所流域 我们将使用NIDA的搜索，测试，治疗和保留的经济弱势社区领域 范式寻求480对夫妇（18至30岁）。集水区的诊所将被随机分配给艾滋病毒 测试服务（HTS）和/或CHC+。较早的研究证明了夫妻的功效 干预AOD使用，性别风险，性别角色和HIV发病率，但没有结合艺术和准备 （对待）;它也没有纳入诊所来解决服务提供的污名（治疗和保留）。 具体目的是：目标1。修改CHC干预以在形成阶段中包括艺术/准备 以及我们社区合作委员会和同行顾问委员会的审查。目标2。评估 减少污名培训对诊所工作人员对年轻妇女的态度和行为的影响 他们的主要男性伴侣寻求艾滋病毒服务（测试/艺术/准备）以及其他性和生殖 在6个和12个月的诊所工作人员的卫生服务。目标3。测试CHC+的功效以增加两者 合作伙伴的准备/艺术启动和依从性（在3、6、9和12个月），减少AOD使用，性风险 和GBV，并增强相对于HTS的正性别规范和沟通（在6和12个月时）。 目标4。通过混合方法检查污名训练的相互作用和CHC+ ON的相互作用 增加年轻妇女及其主要的年轻妇女的准备和艺术启动，保留和遵守 合作伙伴。 如果这种多级方法表明在增加准备和艺术启动，遵守和 保留，它可以帮助实现无法检测到的=不可传输的目标（u = u）目标。如果成功，该项目 可以帮助南非和美国的政府确定扩大的新方法 年轻夫妇的艾滋病毒预防和护理持续性艾滋病毒风险。