GODDESS (Gathering Online for Dialogue and Discussion to Enhance Social Support): Engaging young African American women in a virtual group app to address alcohol misuse, sexual risk, and PrEP in NC

项目总结/摘要 酒精和其他药物（AOD）使用之间的交叉在年轻的非洲裔美国妇女， 艾滋病风险是一个公共卫生问题。最近的流行病学数据突出表明，滥用酒精的情况有所增加 年轻的非洲裔美国女性，特别是自COVID-19以来。这些问题与 非洲裔美国年轻人在艾滋病毒和其他性传播感染方面的持续差异 妇女消除艾滋病毒感染方面持续存在的差距是结束艾滋病毒流行的关键，特别是在 美国南部。因此，迫切需要减少饮酒和性功能受损， 增加暴露前预防（PrEP）的使用，作为这一关键人群的预防措施。 这项拟议中的研究建立在数十年来对以女性为中心的最佳证据干预的研究基础上， 包括与卫生部门合作，解决使用AOD、性风险和暴力预防问题。 最近，研究小组发现，通过移动的健康（mHealth）进行干预的结果 与面对面分娩相比，重度饮酒和性功能受损的几率降低，这表明 通过mHealth的可扩展性是一个可行的选择。下一个合乎逻辑的步骤是添加和测试虚拟组 部分，因为最近参与者对北美非裔美国妇女的几项研究的反馈， 卡罗莱纳已经表现出额外的团体参与和支持是非常期望的。因此，作为回应， 根据RFA-AA-21-016：艾滋病毒预防和酒精，本申请涉及以下具体目标： 目标1.修改基于证据的mHealth AOD使用和性风险降低干预措施， 包括虚拟组组件和关于用于利用PrEP的信息。初步研究活动 包括与24名滥用酒精和16项服务非洲裔美国年轻妇女进行重点小组讨论 提供商，以及虚拟组组件的预测试。这个简短的迭代过程将包括 根据内容（PrEP）和技术（从平板电脑到智能手机）进行修改和改进， 包括我们社区合作委员会的审查。 目标二。测试修改后的mHealth干预（具有组组件）相对于mHealth 在一项对年轻的非洲裔美国妇女（18至30岁）进行的双臂随机试验中， 滥用酒精总共有500名艾滋病毒阴性的重度饮酒者将被 在两个北卡罗来纳州县注册，并将其转介给当地卫生部门进行PrEP。 评估的生物行为结果将包括减少酒精使用（自我报告和生物，包括 PEth），增加PrEP摄取（自我报告和生物学），降低性风险（自我报告 在3个月、6个月、9个月和12个月随访时，无安全套性行为和艾滋病毒/性传播感染的性行为和生物学检测受损）。 目标3.评估虚拟组组件作为一种策略的可接受性、采用率和成本， 增加与移动健康干预和PrEP利用的参与。将评估可接受性 通过满意度调查和研究后访谈，通过数据分析测量参与度， 组和检查作为干预结果的冥想者，并通过收集有关时间和成本的数据， 实施集团化的资源。

PROJECT SUMMARY/ABSTRACT The intersection between alcohol and other drug (AOD) use among young African American women at risk for HIV is a public health issue. Recent epidemiological data highlight increases in alcohol misuse among young African American women, especially since COVID-19. These issues are coupled with persistent disparities in HIV and other sexually transmitted infections (STIs) for young African American women. Eliminating persistent disparities in HIV acquisition is key to ending the HIV epidemic, particularly in the U.S. South. Consequently, there is a critical need to decrease alcohol use and impaired sex and to increase pre-exposure prophylaxis (PrEP) uptake as prevention for this key population. The proposed study builds on decades of research of a best-evidence woman-focused intervention, including collaboration with health departments to address AOD use, sexual risk, and violence prevention. Most recently, the study team found the delivery of the intervention via mobile health (mHealth) had findings comparable with face-to-face delivery, with reduced odds of heavy alcohol use and impaired sex, suggesting that scalability via mHealth is a viable option. The next logical step is to add and test a virtual group component, as recent participant feedback across several studies with African American women in North Carolina has shown additional group engagement and support is highly desired. Consequently, in response to RFA-AA-21-016: HIV Prevention and Alcohol, this application addresses the following specific aims: Aim 1. To modify an evidence-based mHealth AOD use and sexual risk reduction intervention to include a virtual group component and information about PrEP for utilization. Initial research activities include focus group discussions with 24 African American young women who misuse alcohol and 16 service providers, as well as pretesting of the virtual group component. This brief iterative process will include modifications and refinements based on content (PrEP) and technology (from tablet to smartphone) and will include review from our Community Collaborative Board. Aim 2. To test the modified mHealth intervention (with the group component) relative to the mHealth intervention in a two-arm randomized trial with young African American women (aged 18 to 30) who misuse alcohol. A total of 500 participants who are HIV-negative who engage in heavy alcohol use will be enrolled across two North Carolina counties and referred to their local health departments for PrEP. Primary biobehavioral outcomes assessed will include reduced alcohol use (self-reported and biological, including PEth), increased PrEP uptake (self-reported and biological), and reduced sexual risk (self-reported condomless sex and impaired sex and biological testing for HIV/STIs) at 3-, 6-, 9-, and 12-month follow-ups. Aim 3. To assess acceptability, adoption, and cost of the virtual group component as a strategy to increase engagement with the mHealth intervention and PrEP utilization. Acceptability will be assessed via satisfaction surveys and post-study interviews, adoption via data analytics measuring engagement in the group and examined as a meditator of intervention outcomes, and cost via data collected about time and resources of implementing the group component.