The Elimination of Health Disparities through Translation Research

描述（由申请人提供）：我们建议评估艾滋病毒/性病预防干预措施的可翻译性，即在美国印第安人和阿拉斯加原住民（AI/AN）青年中进行的抗艾滋病ECT。在公共性病诊所，在种族和种族异质性的异性恋成年人（15 -39岁）人群中，已证明ECOECT可有效降低性风险行为和性传播疾病（STD）的发病率。这些发现为AI/AN带来了巨大的希望，这是一个承担全国性病水平2-4倍的群体。事实上，印度卫生局（IHS）的12个服务区中有11个显示沙眼衣原体（衣原体）的比率高于美国平均水平，其中3个服务区的水平高出5-6倍。15-19岁的艾滋病/非艾滋病青少年在大多数性传播疾病中所占的比例不成比例，在IHS服务地区报告的所有衣原体和奈瑟氏淋病（淋病）病例中分别占34%和28%。这是由若干因素造成的。与其他青少年一样，人工智能/人工智能青年的生物脆弱性增加，面临交通限制（特别是在距离很远的保留地或村庄环境中），并且不愿意使用为成年人设计的服务。那些生活在农村或保留地环境中的人特别担心在他们往往很小和联系紧密的社区中获得保密的护理。最后，AI/AN青少年与全国同龄人相比，经历了更高水平的性风险行为。疾病控制和预防中心（CDC）已经认识到这个问题，最近开始努力在AI/AN社区实施以学校为基础的衣原体筛查。正如疾病预防控制中心在这项工作中所指出的，在人工智能/学校诊所进行的性病筛查也通过咨询提供了预防的关键点;推荐将经证实的艾滋病毒/性病预防干预措施-抗艾滋病电休克疗法作为一种模式。然而，到目前为止，还没有研究的可行性，或外部有效性，在AI/AN社区存在。与此同时，几乎没有传播研究来描述AI/AN社区的因素和过程，这些因素和过程可能有助于广泛使用任何基于证据的干预措施，更不用说由于性活动的耻辱和价值观而可能招致特别阻力的干预措施了。如果我们要有效地解决艾滋病毒/性传播疾病和青年人性冒险方面令人生畏的差距，我们需要了解人工智能/人工智能社区的外部有效性和传播过程。为此，我们提出以下建议：[1]通过部落伙伴关系，区域联盟和国家合作，我们将使用创新扩散理论来指导AI/AN社区的ECOECT传播计划的制定; [2]使用增强外部有效性的RE-AIM框架，我们将在特定AI社区的校本诊所中实施ECOECT干预;[3]使用RE-AIM框架，我们将在特定AI社区中实施ECOECT干预。[3]在[1]和[2]的基础上，对CO2 ECT的潜在扩散进行了评价。

DESCRIPTION (provided by applicant): We propose to assess the translatability of an HIV/STD prevention intervention called RESPECT among American Indian and Alaska Native (AI/AN) youth. RESPECT has been shown to be efficacious in reducing sexual risk behaviors and the incidence of sexually transmitted diseases (STDs) in public STD clinics among ethnically and racially heterogeneous heterosexual adult (ages15-39) populations. Such findings hold great promise for AI/ANs, a group that shoulders 2-4 times the level of STDs nationally. In fact, 11 of the 12 service areas of the Indian Health Service (IHS) show rates of Chlamydia trachomatis (Chlamydia) higher than the US average, with 3 of these service areas at levels 5-6 times higher. AI/AN adolescents ages 15-19 bear a disproportionate share of most STDs, comprising 34% and 28% of all Chlamydia and Neisseria gonorrhea (gonorrhea) cases, respectively, reported in IHS services areas. This is due to a number of factors. Like other adolescents, AI/AN youth have increased biological vulnerability, face transportation limitations (especially in reservation or Village settings where distances are great), and are reluctant to use services designed for adults. Those in rural or reservation settings are especially concerned about receiving confidential care in their often small and close-knit communities. Finally, AI/AN youth experience higher levels of sexual risk behaviors compared to others in their age group nationally. The Centers for Disease Control and Prevention (CDC) have recognized this problem, and recently initiated an effort to implement school-based Chlamydia screening in AI/AN communities. As noted by the CDC in that effort, STD screening at AI/school clinics also provides a critical point of prevention through counseling; RESPECT, a proven HIV/STD prevention intervention, was recommended as a model. As yet, however, no research on the viability, or external validity, of RESPECT in AI/AN communities exists. At the same time, little dissemination research exists to delineate the factors and processes in AI/AN communities which might facilitate the widespread use of any evidence-based intervention, let alone one that may incur particular resistance because of stigma and values surrounding sexual activity. We need to know about the external validity and the dissemination processes in AI/AN communities if we are to address effectively the daunting disparities in HIV/STDs and sexual risk-taking among youth. To do this, we propose the following: [1] With tribal partnerships, regional alliances, and national collaboration, we will use the Theory of Diffusion of Innovations to guide the development of a dissemination plan for RESPECT with AI/AN communities; [2] using the RE-AIM framework of enhancing external validity, we will implement the RESPECT intervention in school-based clinics in a specific AI community; and [3] evaluate the potential diffusion of RESPECT based on the results of [1] and [2].