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，特别是美国少数民族、低收入和贫困妇女中，妇女的发病率不成比例地增加。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一些方法，以减少异性恋者感染艾滋病毒的风险。这项为期5年的研究名为“通过多层次社区干预促进妇女发起的预防方案来加强艾滋病毒预防”，其目标是增加社区对女用避孕套（FC）的可获得性、可及性和支持，女用避孕套是目前最有效的妇女发起的艾滋病毒/性传播感染预防方案。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持续的方式推进这一问题。本研究将采用以社区为基础的方法，通过动员和建设一组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。这项社区干预的综合动态试验（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。本研究的目的是：1)建立地方社区行动和倡导委员会（CAABs），并建立其能力，以制定、实施和评估旨在促进社区中FC的可用性、可及性和支持的多层次干预措施；2)协助caab制定和调整干预措施，以一致的信息/材料促进社区多层次的FC；3)在两个研究社区中，依次实施和测试多层次干预的能力，以提高组织中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)手工编制CAAB培训方案，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的核心要素。CDT将在提供保健、生殖和性信息及产品的所有地方组织和企业中，每6个月进行一次密集和反复的人种学过程和结果评价，反复进行社区评估（观察和访谈），以记录社区和组织一级的变化。以及每12个月对高危目标人群进行3次横断面调查，以评估CAAB干预措施对社区高危人群的影响和效果。

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.