Rapid HIV Testing and Counseling in High Risk Women in Shelters

描述(由申请人提供)：及早了解艾滋病毒状况对于防止传播给其他人、将艾滋病毒阳性者与医疗保健和服务联系起来、减少发病率和死亡率、提高生活质量以及减少卫生保健支出至关重要。国家艾滋病毒/艾滋病战略一贯确立了一个目标，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%。这项拟议的研究是对PA-11-119“美国服务不足者的艾滋病毒/艾滋病检测和跟进”的直接回应，并提议调查家庭暴力庇护所居民快速艾滋病毒检测和咨询方案的可接受性、可行性和初步效果。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IPV与艾滋病毒/性传播感染风险之间的联系(例如，无保护措施的性行为增加、与有风险的伴侣发生性行为、交易性行为、多性伴)。此外，IPV与获得适当医疗保健的许多障碍有关(例如，运输困难、儿童保育需求、安全问题、缺乏医疗保险)。目前有家庭庇护所 为妇女提供保健服务的适当环境，提供安全和支持性的检测环境，同时解决避难所居民面临的许多检测和与护理挂钩的障碍。REPORT-2是一种基于证据的疾病预防控制中心有效行为干预传播(DEBI)，利用与快速检测相结合的以客户为中心的交互式艾滋病毒风险降低咨询模型。然而，家庭收容所的居民面临着不同的艾滋病毒风险因素，例如难以协商避孕套的使用情况。 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，我们的目标是扩大我们目标人群的REPORT-2(即，REPORT-IPV)，并在100名高危庇护妇女样本中收集关于REPORT-IPV+快速检测的可行性、可接受性和初步疗效的初步数据。还将探讨可接受性的预测因素(例如，创伤后应激障碍症状、药物使用、IPV严重性、以前的检测史、艾滋病毒知识、艾滋病毒危险行为、艾滋病毒焦虑、变化阶段)。我们的主要假设是，在避难所后1周和3个月，尊重-IPV将减少无保护措施的阴道或肛门性行为次数，并在离开避难所3个月后减少阴道滴虫病病例。 公共卫生相关性：拟议的研究调查了一项创新的艾滋病毒快速检测和咨询方案(即，尊重-IPV)在弱势、服务不足的人群(即家庭暴力庇护所的妇女)中的可行性、可接受性和初步效果。在家庭收容所内提供快速艾滋病毒检测和咨询服务，可以接触到大量总体感染艾滋病毒风险较高的妇女，同时大大减少了收容所居民在检测和护理方面面临的许多障碍。检测和咨询方案是创新的，因为它解决了与避难所居民相关的许多不同的艾滋病毒风险因素(例如，谈判使用避孕套的困难 出于对施虐者报复的恐惧)；它还关注尊重-IPV的未来可持续性和传播，让社区疾控中心的培训人员支持咨询、检测和转介网站进行测试和咨询方案。

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.