Enhancing HIV Prevention Through a Multi-level Community Intervention To Promote

描述(申请人提供)：异性传播艾滋病毒仍然是扭转疫情的最顽固的问题之一，在某些人群中，妇女的发病率不成比例地增加，特别是美国少数民族、低收入和贫困妇女。至关重要的是，妇女必须拥有所有有效的预防方法，包括她们可以发起和控制的方法，以减少异性恋艾滋病毒的风险。这项为期5年的研究题为“通过多层次社区干预加强艾滋病毒预防，以促进妇女发起的预防选择”，其目的是增加社区对使用女用避孕套(FC)的可获得性、可及性和支持，因为它是目前由妇女发起的艾滋病毒/性传播感染预防选择中最有效的。越来越多的证据支持发展理论驱动的多层次干预措施，利用社区赋权模式动员社区各部门以可持续的方式推动这一问题。这项研究将使用以社区为基础的方法，通过动员和建设关键社区代理机构的能力来制定和实施多层次的社区干预措施，这些机构将在社区、组织和个人层面共同制定和实施干预措施，以实现项目目标。社区干预的全面动态试验(CDT)将首先在康涅狄格州哈特福德进行，然后在康涅狄格州新不列颠重复进行，以确定复制所需的核心过程和内容。这项研究的目的是：1)创建地方社区行动和倡导委员会(CAAB)，并建设其能力，以开发、实施和评估旨在促进其社区中FC的可获得性、可及性和支持的多层次干预措施；2)协助CAAB定制和定制干预措施，以一致的信息/材料针对社区的多个层面推广FC；3)在两个研究社区中依次实施和测试多级干预措施的能力，以增加组织中FC的可得性、可及性和支持，并提高该社区中高危妇女及其伴侣请求、尝试和使用FC的意识、知识、使用和谈判技能、获得机会的能力以及使用FC的意愿和效力；4)评估CAAB和CAAB制定的干预措施的可持续性；5)使CAAB培训方案具体化，并确定适应和在其他社区实施所需的基于社区的多级干预的核心要素。CDT将使用密集和迭代的人种学过程和结果评估，在所有提供健康、生殖和性信息和产品的当地组织和企业中每6个月重复一次社区评估(观察和访谈)，以记录社区和组织层面的变化，并每12个月对高危目标人口成员进行3次横断面调查，以评估CAAB干预措施对社区目标高危部门个人的影响和影响。 公共卫生相关性：拟议的研究将测试社区参与性方法，以制定和实施多层次社区干预，以增加对女性避孕套(FC)的可获得性、可及性和支持，从而增加对减少异性传播艾滋病毒的使用。在两个研究城镇各建立一个地方社区联盟(社区行动和宣传委员会--CAAB)，旨在提高CAAB制定和实施的多层次干预措施(S)的地方相关性和有效性，并增强其社区干预效果的可持续性。

DESCRIPTION (provided by applicant): Heterosexual HIV transmission continues to be one of the most tenacious problems for reversing the epidemic, and incidence among women increases disproportionately in certain populations, particularly U.S. ethnic minorities, low-income and impoverished women. It is essential that women have available all effective prevention methods, including some they can initiate and control, in order to reduce heterosexual HIV risk. The goal of this 5-year study entitled, "Enhancing HIV Prevention Through Multi-level Community Intervention to Promote Women-Initiated Prevention Options," is to increase the community availability, accessibility, and support for use of the female condom (FC), as currently the most effective woman-initiated HIV/STI prevention option. Evidence increasingly supports the development of theoretically driven multi-level interventions, using a community-empowerment model to mobilize sectors of the community to move the issue forward in a sustained way. This study will use a community-based approach to develop and implement a multi-level community intervention by mobilizing and building the capacity of a body of key community agents, who will collectively develop and implement interventions at the community, organizational, and individual levels to achieve the project goals. A comprehensive dynamic trial (CDT) of this community intervention will be conducted first in Hartford, CT, and then repeated in New Britain, CT to identify core process and content needed for replication. The aims of the study are to: 1) create local Community Action and Advocacy Boards (CAABs) and build their capacity to develop, implement and evaluate a multi-level intervention designed to promote availability, accessibility, and support for FC in their community; 2) assist the CAABs to customize and tailor interventions promoting FC targeting multiple levels of the community with consistent messages/materials; 3) in two study communities sequentially, implement and test the ability of the multi-level intervention to increase availability, accessibility, and support for FC in organizations, and to increase awareness, knowledge, use and negotiation skills, ability to access, and willingness and efficacy to request, try, and use the FC among at-risk women and their partners in that community; 4) assess the sustainability of the CAABs and the CAAB- developed interventions; and 5) manualize the CAAB training protocol, and identify core elements of the community-based multi-level intervention needed for adaptation and implementation in other communities. The CDT will use intensive and iterative ethnographic process and outcome evaluation, repeated community assessments (observations and interviews) every 6 months in all local organizations and businesses that provide health, reproductive and sex information and products to document community and organizational level changes, and 3 cross-sectional surveys with at-risk target population members every 12 months to assess the impact and effects of the CAAB interventions on individuals in targeted high risk sectors of the community. PUBLIC HEALTH RELEVANCE: The proposed study will test a community participatory approach to developing and implementing a multi-level community intervention to increase availability, accessibility, and support for female condoms (FC), thereby increasing their use for the reduction of heterosexually transmitted HIV. Creation and capacity building of a local community coalition (the Community Action and Advocacy Board-CAAB) in each of two study towns is designed to increase local relevance and effectiveness of the CAAB-developed and implemented multi-level intervention(s) and to increase sustainability of intervention effects in their community.