CAMELLIA Cohort: A longitudinal study to understand sexual health and prevention among women in Alabama

摘要 尽管有有效的艾滋病毒预防工具，如暴露前预防（PrEP）， 有色人种社区之间的差距仍然存在，特别是在南方腹地的妇女中， 黑人妇女的艾滋病毒感染率是白色妇女的14倍。PrEP利用率仍然 在南方腹地的妇女中，估计<7%的合格妇女在亚拉巴马接受PrEP。 此外，确定PrEP资格的算法显示出对女性的预测能力较差。该提案 利用来自以下领域的经验丰富的艾滋病毒预防调查人员的动态和创新合作 伯明翰大学，北卡罗来纳大学教堂山分校，艾滋病研究中心， 亚拉巴马公共卫生部（ADPH）和社会科学系统。这项新颖的研究 该提案利用基于人口的方法建立一个具有地理代表性的顺式和反式队列 根据最近的研究，跨性别妇女（“山茶花群”）未来感染艾滋病毒的风险很大， 淋病或梅毒感染，整个亚拉巴马州（AL），被强调为地理热点， 联邦终止艾滋病毒流行战略，以更好地了解与性传播感染和艾滋病毒风险相关的因素 PrEP使用的诊断和预测因素。该提案的目的是：（1）完善健康赋权 (HMP)数字平台，以前用于提供循证干预措施，以改善艾滋病毒和 与男性发生性关系的黑人男子和变性妇女的预防成果，包括关键的 在AL中最佳地吸引和留住一批有艾滋病毒风险的妇女的要素;这将通过以下方式实现： 利益相关者与自我认定的妇女进行研究，使用PrEP和PrEP护理团队成员 名义组技术; 2）招募和保留800名地理多样化和农村增强的队列 年龄在18-44岁的妇女，最近淋病或梅毒检测呈阳性， 招募，利用地理多样性抽样框架参与山茶花数字队列 利用公共和商业上可获得的县级年度艾滋病毒和性传播感染检测数据，以及3）评估 茶花地区STI/HIV发病率和PrEP使用和依从性的预测因子、中介因子和调节因子 通过HMP数字平台收集人口统计学、行为和社区水平评估进行队列研究 和艾滋病毒/性病检测通过ADPH的家庭检测计划定期;我们将有目的地采样 对队列中艾滋病毒易感性高和/或使用PrEP的妇女进行深入访谈（n = 30），以进一步 探索影响PrEP使用的因素，以指导未来的干预发展。这项研究将奠定 为一个更大的研究项目测试进一步适应HMP数字平台的实施奠定基础 旨在改善南方腹地妇女的艾滋病毒/性传播感染检测、PrEP利用率和持久性， 重点是艾滋病毒发病率较高的地区。

Abstract Despite the availability of effective HIV prevention tools such as pre-exposure prophylaxis (PrEP), significant disparities persist among communities of color, particularly among women in the Deep South where the rate of HIV infection is fourteen-times higher for Black women compared to White women. PrEP utilization remains low among women in the Deep South with estimates of <7% eligible women receiving PrEP in Alabama. Moreover, algorithms to determine PrEP eligibility demonstrate poor predictive power for women. The proposal takes advantage of a dynamic and innovative collaboration of experienced HIV-prevention investigators from the University of Alabama-Birmingham, University of North Carolina-Chapel Hill, Centers for AIDS Research, the Alabama Department of Public Health (ADPH), and Social Scientific Systems. This novel research proposal utilizes a population-based approach to establish a geographically representative cohort of cis- and trans-gender women (‘Camellia Cohort’) at significant risk for future HIV acquisition, based on recent gonorrhea or syphilis infection, across the state of Alabama (AL), highlighted as a geographic hotspot by the federal Ending the HIV Epidemic strategy, to better understand factors associated with risk of STI and HIV diagnosis and predictors for PrEP use. The aims of this proposal are to: 1) refine the HealthMpowerment (HMP) digital platform, previously utilized to deliver evidence-based interventions to improve HIV and prevention outcomes among Black men who have sex with men and transgender women, to include key elements that optimally engage and retain a cohort of women at-risk for HIV in AL; this will be achieved via stakeholder engaged research with self-identified women on PrEP and PrEP care team members using nominal group techniques; 2) recruit and retain a geographically-diverse and rurally-enhanced cohort of 800 women ages 18-44, with recent positive gonorrhea or syphilis testing who are STI- and HIV-uninfected at enrollment, to participate in the Camellia digital cohort utilizing a geographically diverse sampling framework using public and commercially available annual county-level HIV and STI testing data and 3) evaluate predictors, mediators and moderators for STI/HIV incidence and PrEP use and adherence in the Camellia Cohort by collecting demographic, behavioral, and community level assessments via the HMP digital platform and HIV/STI testing through ADPH’s home testing program at regular intervals; we will purposefully sample women with high HIV vulnerability and/or PrEP use within the cohort for in-depth interviews (n = 30) to further explore factors contributing to PrEP use to guide future intervention development. This research will lay the groundwork for a larger research program testing the implementation of a further adapted HMP digital platform designed to improve HIV/STI testing, PrEP utilization and persistence among women in the Deep South, focusing on areas with higher HIV incidence.