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

描述（由申请人提供）：异性恋艾滋病毒传播仍然是扭转这一流行病的最棘手的问题之一，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，妇女应掌握所有有效的预防方法，包括她们可以主动采取和控制的一些方法，以减少异性恋感染艾滋病毒的风险。这项为期五年的研究题为“通过多层次社区干预加强艾滋病毒预防，促进妇女主动提出的预防选择”，其目标是增加社区对使用女用避孕套的可获得性、可获得性和支持，这是目前妇女主动提出的最有效的艾滋病毒/性传播感染预防选择。越来越多的证据支持制定理论驱动的多层次干预措施，使用社区赋权模式，动员社区各部门以可持续的方式推动这一问题。这项研究将采用以社区为基础的方法，通过动员和建设一批关键社区代理人的能力，制定和实施多层次的社区干预措施，这些代理人将在社区、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。一个全面的动态试验（CDT），这种社区干预将首先在哈特福德，CT，然后重复在新英国，CT，以确定复制所需的核心过程和内容。本研究的目的是：1）建立当地社区行动和宣传委员会（CAAB），并建立其制定、实施和评估多层次干预措施的能力，这些干预措施旨在促进社区的家庭保育的可用性、可及性和支持; 2）协助CAAB定制和调整针对社区多层次的家庭保育的干预措施，并提供一致的信息/材料; 3）在两个研究社区中，依次实施和测试多层次干预的能力，以增加组织中FC的可用性、可及性和支持，并增加该社区中高危妇女及其伴侣对FC的认识、知识、使用和谈判技能、获取能力、请求、尝试和使用FC的意愿和有效性;（4）评估CAAB和CAAB制定的干预措施的可持续性;（5）将CAAB培训方案手册化，并确定在其他社区适应和实施所需的基于社区的多层次干预措施的核心要素。CDT将使用密集和迭代的民族志过程和结果评估以及重复的社区评估（观察和访谈）每6个月在所有提供健康、生殖和性信息和产品的地方组织和企业中进行一次，以记录社区和组织一级的变化，和3个横截面调查，每12个月评估CAAB干预措施对目标高危人群的影响和效果，社会各界 公共卫生相关性：拟议的研究将测试一种社区参与的方法，以制定和实施多层次的社区干预措施，以增加女用避孕套（FC）的可用性、可获得性和支持，从而增加其使用，减少异性性传播艾滋病毒。在两个研究城镇中的每一个建立地方社区联盟（社区行动和宣传委员会）并进行能力建设，旨在提高社区行动和宣传委员会制定和实施的多层次干预措施的地方相关性和有效性，并提高干预措施在社区的可持续性。

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.