Epidemiologic Study on Changing HIV Risks Among FSW-IDUs on the Mexico-US Border

墨西哥-美国边境 FSW-IDU 人群 HIV 风险变化的流行病学研究

• 批准号: 8014935
• 负责人: STEFFANIE A. STRATHDEE
• 金额: $ 60.44万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-02-01 至 2013-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8014935
• 关键词: Accounting; Adult; Age; Alcohol or Other Drugs use; Anal Sex; Attitude; Bacterial Vaginosis; Behavior; Behavior Therapy; Birth Place; Budgets; California; Characteristics; Child; Chlamydia; Cities; Client; Clinic; Communities; Congenital Syphilis; Consult; Consumption; Country; Data Collection; Drug usage; Education; Environment; Epidemic; Epidemiologic Studies; Epidemiology; Expectancy; Female; Feminine; Fluorescent Dyes; Foundations; General Population; Goals; Gonorrhea; Gossypium; Government; HIV; HIV Seropositivity; HIV/STD; Herpes zoster disease; Hygiene; Incentives; Infant Food; Injection of therapeutic agent; Intervention; Intervention Studies; Joints; Knowledge; Laboratories; Light; Maps; Marketing; Methods; Mexican; Mexico; Modeling; Needle Sharing; Needle-Exchange Programs; Needles; Outcome; Pattern; Pharmaceutical Preparations; Pilot Projects; Play; Population; Prevalence; Prevention; Principal Investigator; Publishing; Randomized; Recommendation; Recruitment Activity; Reporting; Research; Research Personnel; Resources; Risk; Risk Reduction; Role; Route; Secure; Self Efficacy; Sex Behavior; Shares syringes; Shipping; Ships; Side; Sister; Site; Soaps; Source; Specimen; Subgroup; Suggestion; Syphilis; Syringes; Testing; Time; Toy; Translating; Trichomonas Infections; Vagina; Visit; Water; Woman; Work; aged; base; condoms; contextual factors; cost; depressive symptoms; design; efficacy testing; experience; family structure; follow-up; group intervention; high risk; high risk behavior; improved; intervention effect; intimate partner violence; male; meetings; motivational enhancement therapy; peer; pleasure; policy implication; primary outcome; programs; response; safer sex; self esteem; sex; social; three-arm study; trafficking; voucher

DESCRIPTION (provided by applicant): Globally, FSWs who inject drugs (FSW-IDUs) are important `bridge' populations that can transmit HIV/STIs to the general population; however, interventions to reduce both their injection and sexual risks are lacking. The overall goal of this epidemiologic study is to simultaneously reduce high risk sexual and injection behaviors among FSW-IDUs in two Mexico-U.S. border cities, among whom HIV prevalence has recently increased from 2% to 14%; 46% had at least one active STI. Our specific aims are: Aim 1) To evaluate the efficacy of a behavioral intervention to decrease sharing of syringes and injection paraphernalia among FSW-IDUs. We hypothesize that FSW-IDUs in the active experimental injection risk reduction condition will report: (a) less receptive and distributive needle sharing; (b) less sharing of injection paraphernalia; (c) obtaining syringes and injection paraphernalia from safer sources. Aim 2) To evaluate efficacy of a behavioral intervention to increase condom use among FSW-IDUs in the context of ongoing drug use. We hypothesize that FSW-IDUs in the active experimental sexual risk reduction condition will: (a) report less unprotected vaginal and anal sex; (b) have fewer incident cases of specific STIs. Aim 3) To evaluate the joint effects of these two behavioral interventions to increase condom use and reduce sharing of needles/injection paraphernalia among FSW- IDUs. We hypothesize that the joint effect of these interventions will generate greater risk reductions compared to either intervention alone. Aim 4) To determine the extent to which theoretically-important components of our interventions (i.e., self-efficacy, outcome expectancies, attitudes, intentions) represent underlying mechanisms of change in primary outcomes (i.e., sexual and injection-related risk reductions). Aim 5) To explore subgroup differences in the efficacy of a) the sexual risk reduction intervention and b) the injection risk reduction intervention based on background characteristics, contextual factors, social factors and intrapersonal factors. To meet these aims, we will recruit 600 HIV-negative FSW-IDUs (300 each in Tijuana and Cd. Juarez) and randomize women to one of three time-equivalent groups (Group 1: injection risk intervention and didactic safer sex education; Group 2: sexual risk intervention and didactic safer injection education; Group 3: Both active injection and sexual interventions). In each city, cluster randomization will be used to minimize contamination. All women receive free STI treatment and will be followed-up at 4, 8 and 12 months. Our design allows us to `unpack' the intervention to determine whether its components are just as effective in reducing injection and/or sexual risks, or if the more intensive conditions are needed to alter the epidemiology of HIV/STIs, thus having direct, tangible policy implications for Mexico and the US. Interventions that reduce HIV risks among FSW-IDUs may curtail the burgeoning HIV epidemic in the U.S-Mexico border region, and have applicability to other resource-poor countries.Globally, FSWs who inject drugs (FSW-IDUs) are important `bridge' populations that can transmit HIV/STIs to the general population; however, interventions to reduce both their injection and sexual risks are lacking. The overall goal of this epidemiologic study is to simultaneously reduce high risk sexual and injection behaviors among FSW-IDUs in two Mexico-U.S. border cities, among whom HIV prevalence has recently increased dramatically. To our knowledge, this is the first study of its kind to be tested in any country, findings from which have particular relevance to resource-constrained environments.

描述（由申请人提供）：在全球范围内，注射吸毒的 FSW（FSW-IDU）是重要的“桥梁”人群，可以将 HIV/STI 传播给普通人群；然而，缺乏减少注射和性行为风险的干预措施。这项流行病学研究的总体目标是同时减少墨西哥和美国两个地区 FSW-IDU 的高风险性行为和注射行为。边境城市，其中艾滋病毒感染率最近从2%上升到14%； 46% 的人至少患有一种活跃的性传播感染。我们的具体目标是： 目标 1) 评估行为干预对于减少 FSW-IDU 之间共用注射器和注射用具的有效性。我们假设，在主动实验注射风险降低条件下，FSW-IDU 将报告：(a) 较少接受和分配针头共享； (b) 减少共用注射用具； (c) 从更安全的来源获取注射器和注射用具。目标 2) 评估行为干预的有效性，以增加 FSW-IDU 在持续吸毒的情况下使用安全套。我们假设，在活跃的实验性性风险降低条件下，FSW-IDU 将： (a) 报告较少的无保护阴道性交和肛交； (b) 特定性传播感染的病例较少。目标 3) 评估这两种行为干预措施的联合效果，以增加 FSW-IDU 中安全套的使用并减少共用针头/注射用具。我们假设，与单独的干预措施相比，这些干预措施的联合作用将产生更大的风险降低。目标 4) 确定干预措施中理论上重要的组成部分（即自我效能、结果预期、态度、意图）在多大程度上代表主要结果变化的潜在机制（即性和注射相关风险降低）。目标 5) 基于背景特征、背景因素、社会因素和个人因素，探讨 a) 性风险降低干预措施和 b) 注射风险降低干预措施的功效的亚组差异。为了实现这些目标，我们将招募 600 名 HIV 阴性 FSW-IDU（蒂华纳和华雷斯城各 300 名），并将女性随机分为三个时间相当的组之一（第 1 组：注射风险干预和说教性安全性行为教育；第 2 组：性风险干预和说教性安全注射教育；第 3 组：主动注射和性干预）。在每个城市，将采用集群随机化来最大程度地减少污染。所有女性都接受免费性传播感染治疗，并将在 4、8 和 12 个月时进行随访。我们的设计使我们能够“解开”干预措施，以确定其组成部分在减少注射和/或性风险方面是否同样有效，或者是否需要更强化的条件来改变艾滋病毒/性传播感染的流行病学，从而对墨西哥和美国产生直接、切实的政策影响。降低 FSW-IDU 中艾滋病毒风险的干预措施可能会遏制美国-墨西哥边境地区迅速蔓延的艾滋病毒流行，并且适用于其他资源匮乏的国家。在全球范围内，注射吸毒的 FSW-IDU 是重要的“桥梁”人群，可以将 HIV/性传播感染传播给普通人群；然而，缺乏减少注射和性行为风险的干预措施。这项流行病学研究的总体目标是同时减少墨西哥和美国两个地区 FSW-IDU 的高风险性行为和注射行为。近年来，边境城市的艾滋病毒感染率急剧上升。据我们所知，这是第一个在任何国家进行测试的此类研究，其研究结果与资源有限的环境特别相关。