Case Management Alternatives for African American Women at High Risk for HIV

描述（申请人提供）：项目描述。本申请是NI DA赠款#R 01 DA 13131“吸毒女性性工作者的艾滋病毒/HCV/HBV简要干预”的竞争性更新。“这项研究的一个重要发现是，贫穷的街头女性性工作者所经历的一些因素-包括童年创伤、吸毒、无家可归、街头生活、强奸和暴力受害-造成了这一人口的严重健康问题。这些在迈阿密的非洲裔美国妇女中最为关键，因为她们的经济资源水平较低，地处迈阿密最贫穷和被忽视的社区，而且艾滋病毒和其他性传播感染的发病率较高。尽管这些妇女存在各种各样的健康和社会问题，但许多障碍阻碍她们寻求和获得所需的服务。这一相互竞争的更新的目的是测试创新办法，以加强与药物滥用治疗和其他保健服务的联系，并使这些服务不足的人口更多地参与这些服务。建议的应用程序的具体目标是：1）在迈阿密市中心的内城社区招募的550名吸毒、贫困、非洲裔美国妇女的样本中，评估卫生服务需求的性质和程度以及服务利用的障碍; 2）实施两个备选的案件管理条件，以增加与以下方面的联系和利用，通过随机分配参与者到适当的医疗服务：基于优势/专业的条件，其中客户参与“基于优势”的病例管理方法;或，基于优势/专业/同行条件，其中团队由：a）一名有资格的专业个案管理人员和B）一名正在康复的吸毒者/前性工作者-双方都接受过“基于优势”的个案管理技术培训-制定并促进服务计划的实施; 3）通过对客户和提供者进行3个月和6个月的随访，评估这两个条件的有效性，以确定服务联系的程度和服务利用的结果，以及风险行为的变化，因为他们涉及到服务的获取;和，4）在两种条件之间，评估易感性，使能性和疾病/需求因素之间的相互作用模式，并检查其对服务的联系和参与的后续影响。与公共卫生相关。建立一个有效的机制，解决贫困的吸毒非洲裔美国性工作者的健康和服务需求，将改善目标人群的健康状况和生活质量。此外，由于性工作者与多个性伴侣接触，因此，测试治疗和服务联系创新办法的研究在避免新的艾滋病毒/性传播感染、为已感染者提供更早获得医疗的机会以及减少这些感染向更广泛人群的传播方面都有好处。

DESCRIPTION (provided by applicant): Project Description. This application is a competing renewal of NI DA Grant # R01 DA13131, "Brief HIV/HCV/HBV Interventions for Drug-Using Women Sex Workers." An important finding of this study was that a number of factors experienced by indigent, street-based, women sex workers - including childhood trauma, drug use, homelessness, street life, rape and violent victimization -- contribute to serious health problems among this population. These are most critical among African-American women in Miami, given their lower levels of economic resources, their location in Miami's most impoverished and neglected communities, as well as their higher rates of HIV and other sexually transmitted infections (STIs). In spite of the myriad of health and social problems among these women, numerous barriers prevent them from seeking and accessing needed services. The purpose of this competing renewal is to test innovative approaches designed to increase linkages and engagement with drug abuse treatment and other health services among this underserved population. The specific aims of the proposed application are to: 1) assess the nature and extent of health service needs and barriers to service utilization among a sample of 550 drug-involved, indigent, African-American women recruited from inner city neighborhoods in downtown Miami; 2) implement two alternative case management conditions designed to increase linkages to, and utilization of, appropriate health services by randomly assigning participants to: a Strengths-Based / Professional Only Condition in which clients participate in a "strengths-based" case management approach; or, a Strengths-Based / Professional/Peer Condition in which a team composed of: a) a credentialed, professional case manager and b) a recovering addict/former sex worker-peer - both trained in "strengths-based" case management techniques - develop and facilitate the implementation of a service plan; 3) evaluate the effectiveness of these two conditions by conducting 3 and 6-month follow-ups with both clients and providers to determine extent of service linkages and outcomes of service utilization, as well as changes in risk behaviors as they relate to service access; and, 4) both across and between the two conditions, assess the patterns of interaction among predisposing, enabling, and illness/need factors, and examine their effects on services linkage and engagement at follow-up. Relevance to Public Health. Developing an effective mechanism for addressing the health and service needs of indigent drug-using African-American sex workers will improve the health status and the quality of life of the target population. In addition, because sex workers have contacts with multiple sexual partners, research that tests innovative approaches to treatment and service linkage has a benefit in terms of avoiding new HIV/STI infections, providing earlier access to medical treatment for those already infected, and reducing the spread of these infections to a wider population.