Rapid HIV Testing and Counseling in High Risk Women in Shelters

对收容所中的高危妇女进行快速艾滋病毒检测和咨询

• 批准号: 8410235
• 负责人: DAWN M JOHNSON
• 金额: $ 24.76万
• 依托单位: UNIVERSITY OF AKRON
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-23 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8410235
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Alcohol or Other Drugs use; American; Anal Sex; Anxiety; Awareness; Behavior Therapy; Caring; Centers for Disease Control and Prevention (U.S.); Child; Child Care; Client; Clinical; Clinical Services; Clinical Trials; Communities; Counseling; Data; Development; Diffusion; Domestic Violence; Early Diagnosis; Emergency Situation; Environment; Face; Focus Groups; Forcible intercourse; Fright; Future; Goals; HIV; HIV Infections; HIV Seropositivity; Health Expenditures; Health Insurance; Health Services; Healthcare; High Risk Woman; Human Resources; Human immunodeficiency virus test; Injecting drug user; Institutes; Intervention; Knowledge; Left; Life; Link; Literature; Manuals; Mediation; Medical; Modeling; Morbidity - disease rate; Multiple Partners; Pilot Projects; Population; Post-Traumatic Stress Disorders; Preventive Intervention; Protocols documentation; Public Health; Quality of life; Recording of previous events; Reporting; Research; Research Proposals; Risk; Risk Behaviors; Risk Factors; Risk Reduction; Safety; Sampling; Services; Severities; Sex Behavior; Sexual Partners; Sexually Transmitted Diseases; Shelter facility; Site; Staging; Substance Use Disorder; Symptoms; Target Populations; Test Result; Testing; Time; Training; Transportation; Trichomonas Infections; Underserved Population; United States; Unsafe Sex; Vagina; Visit; Vulnerable Populations; Woman; base; condoms; disorder risk; evidence base; follow-up; help-seeking behavior; high risk; high risk sexual behavior; improved; information gathering; innovation; intimate partner violence; meetings; mortality; novel; prevent; programs; response; secondary outcome; sex; transmission process

DESCRIPTION (provided by applicant): Early knowledge of HIV status is critical to prevent transmission to others, to link those who are HIV positive to medical care and services that can reduce morbidity and mortality and improve quality of life, and to reduce health care expenditure. Consistently, the National HIV/AIDS strategy has established a goal of increasing the awareness of HIV status in Americans from 79% to 90% in the next four years. The proposed research is in direct response to PA-11-119, "HIV/AIDS Testing and Follow-up Among the Underserved in the United States," and proposes to investigate the acceptability, feasibility, and initial efficacy of a rapid HIV testing and counseling protocol in residents of domestic violence shelters. Intimate partner violence (IPV) is a pervasive public health problem, and a growing body of research highlights the association between IPV and HIV/STI risk (e.g., increased unprotected sexual occasions, sex with risky partners, trading sex, multiple partners). Further, IPV is associated with many barriers to receiving adequate health care (e.g., transport difficulties, child care needs, safety issues, lack of health insurance). Domestic shelters present an opportune setting for providing health care services for women, providing a safe and supportive environment for testing, while addressing many of the barriers to testing and linkage to care faced by shelter residents. RESPECT-2 is an evidence- based CDC Diffusion of Effective Behavioral Interventions (DEBI), utilizing a client-focused, interactive HIV risk reduction counseling model delivered in conjunction with rapid testing. Residents of domestic shelters, however, face distinct HIV risk factors, such as difficulty in negotiating condom use out of fear of retaliation from their abuser, and thus needs to be tailored to meet the specific needs of shelter residents. Thus, in the proposed exploratory/developmental research plan, we aim to expand RESPECT-2 for our target population (i.e., RESPECT-IPV), and to collect preliminary data on RESPECT-IPV + rapid testing's feasibility, acceptability, and initial efficacy in a sample of 100 high-risk shelter women. Predictors of acceptability (e.g., PTSD symptoms, substance use, IPV severity, prior testing history, HIV knowledge, HIV risk behavior, HIV anxiety, stage of change) will also be explored. Our primary hypotheses are that RESPECT-IPV will be associated with reduced unprotected vaginal or anal sex occasions at 1-week and 3-months post-shelter and fewer cases of vaginal trichomoniasis 3-months after leaving shelter. PUBLIC HEALTH RELEVANCE: The proposed research investigates the feasibility, acceptability, and an initial efficacy of an innovative rapid HIV testing and counseling protocol (i.e., RESPECT-IPV) with a vulnerable, underserved population (i.e., women in domestic violence shelters). Offering rapid HIV testing and counseling within domestic shelters provides access to a significant population of women with an overall high risk for HIV infection while significantly reducing many of the barriers to testing and linkage of care faced by shelter residents. The testing and counseling protocol is innovative in that it addresses many of the distinct HIV risk factors relevant to shelter residents (e.g., difficulty in negotiating condom use out of fear of retaliation from abuser); it also attends to the future sustainability and dissemination of RESPECT-IPV in having trained personnel from community- based CDC supported counseling, testing, and referral sites conduct the testing and counseling protocol.

描述（由申请人提供）：艾滋病毒状况的早期知识是至关重要的，以防止传播给他人，连接那些谁是艾滋病毒阳性的医疗保健和服务，可以降低发病率和死亡率，提高生活质量，并减少卫生保健支出。因此，国家艾滋病毒/艾滋病战略制定了一个目标，即在未来四年内将美国人对艾滋病毒状况的认识从79%提高到90%。这项研究是对PA-11-119“美国服务不足人群中的艾滋病毒/艾滋病检测和随访”的直接回应，并建议调查家庭暴力庇护所居民中快速艾滋病毒检测和咨询方案的可接受性，可行性和初步疗效。亲密伴侣暴力（IPV）是一个普遍的公共卫生问题，越来越多的研究强调了IPV与艾滋病毒/性传播感染风险之间的关联（例如，增加无保护的性场合，与危险性伙伴发生性关系，交易性行为，多个伙伴）。此外，IPV与接受充分医疗保健的许多障碍有关（例如，交通困难、儿童保育需要、安全问题、缺乏健康保险）。国内避难所 为妇女提供保健服务创造了有利的环境，为检测提供了安全和有利的环境，同时解决了收容所居民面临的检测和与护理联系方面的许多障碍。ECOECT-2是一个基于证据的CDC有效行为干预（DEBI）传播，利用以客户为中心的互动式艾滋病毒风险降低咨询模型，与快速检测一起提供。然而，家庭避难所的居民面临着独特的艾滋病毒风险因素，例如难以协商使用避孕套 由于担心遭到施虐者的报复，因此需要根据收容所居民的具体需要进行调整。因此，在拟议的探索性/发展性研究计划中，我们的目标是为我们的目标人群（即，RESPECT-IPV），并收集有关RESPECT-IPV +快速检测的可行性，可接受性和初步疗效的100名高风险庇护所妇女的样本的初步数据。可接受性的预测因素（例如，PTSD症状，物质使用，IPV严重程度，既往检测史，HIV知识，HIV风险行为，HIV焦虑，变化阶段）也将进行探索。我们的主要假设是，RESPECT-IPV将与庇护后1周和3个月的无保护阴道或肛交次数减少以及离开庇护后3个月的阴道滴虫病病例减少相关。 公共卫生关系：拟议的研究调查了一种创新的快速艾滋病毒检测和咨询方案（即，RESPECT-IPV）与脆弱、服务不足的人口（即，家庭暴力庇护所的妇女）。在家庭收容所内提供快速艾滋病毒检测和咨询服务，使大量艾滋病毒感染总体风险高的妇女有机会接触，同时大大减少了收容所居民在检测和护理联系方面面临的许多障碍。测试和咨询协议是创新的，因为它解决了与收容所居民有关的许多不同的艾滋病毒风险因素（例如，使用避孕套的困难 出于对施虐者报复的恐惧）; 2它还关注RESPECT-IPV的未来可持续性和传播，让来自社区CDC支持的咨询、检测和转诊站点的训练有素的人员执行检测和咨询方案。