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

基本信息

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
项目类别：
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

项目摘要

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.

项目概要/摘要南非艾滋病毒感染率最高的是年轻女性，其中许多人与主要伴侣之间经常酗酒和吸食其他药物 (AOD)，此外无套性行为、外部性伴侣和性别暴力 (GBV)。许多年轻女性和她们的伴侣正处于成年早期，这是一个以性风险为特征的关键时期。拟议的修订需要采取综合预防和治疗方法来应对这些交叉流行病。我们建议修改我们对开普敦年轻夫妇的循证夫妇干预措施。拟议的夫妻健康合作计划 (CHC+) 生物行为干预将包括以下信息：以及与 PrEP 和 ART 的联系。我们还将完善诊所的减少耻辱培训，以解决对使用 AOD 和寻求艾滋病毒服务的年轻人的侮辱态度和行为。我们通过采用修改后的析因设计的整群随机试验提出多层次方法，其中 24 诊所随机接受减少耻辱培训或不接受培训。从诊所范围在经济贫困社区的地区，我们将使用 NIDA 的 Seek、Test、Treat 和 Retain 范式寻找 480 对夫妇（18 至 30 岁）。学区的诊所将随机接受艾滋病毒治疗测试服务 (HTS) 和/或 CHC+。早期的一项研究证明了夫妻的功效对 AOD 使用、性风险、性别角色和 HIV 发病率进行干预，但没有纳入 ART 和 PrEP （对待）;它也没有被纳入诊所来解决服务提供（治疗和保留）中的耻辱问题。具体目标是：目标 1. 修改 CHC 干预措施，将 ART/PrEP 纳入形成阶段并经过我们的社区合作委员会和同行咨询委员会的审查。目标 2. 评估减少耻辱培训对诊所工作人员对年轻女性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（检测/ART/PrEP）以及其他性和生殖服务 6 个月和 12 个月大时由诊所工作人员提供的保健服务。目标 3. 测试 CHC+ 提高两者的功效伴侣的 PrEP/ART 启动和坚持（第 3、6、9 和 12 个月），并减少 AOD 使用和性风险和 GBV，并加强与 HTS 相关的积极性别规范和沟通（6 个月和 12 个月时）。目标 4. 通过混合方法检验减少耻辱感培训与 CHC+ 之间的相互作用提高年轻女性及其主要参与者的 PrEP 和 ART 启动、保留和依从性合作伙伴。如果这种多层次方法证明能够有效提高 PrEP 和 ART 的启动、依从性和保留，它可以帮助实现不可检测=不可传输（U=U）的目标。如果成功的话，该项目可以帮助南非和美国政府找到扩大对有艾滋病毒风险的年轻夫妇进行艾滋病毒连续预防和护理。