Cambodia Integrated HIV and Drug Prevention Implementation Program

描述(申请人提供)：在柬埔寨，女性娱乐性工作者(FESWs)是艾滋病毒风险最高的群体之一：艾滋病毒的流行率和发病率很高，使用非注射苯丙胺类兴奋剂(ATS)也是如此。我们在那里的研究表明，ATS对艾滋病毒风险有很大贡献。这项拟议的研究将评估实施新的组合艾滋病毒预防干预方案(药物滥用预防和小额融资工具)的影响，该方案被整合到针对柬埔寨高危FESWs的现有艾滋病毒预防计划(SMART女孩)中。聪明女孩提供一系列教育和外展服务，特别是转介艾滋病毒检测，以及性传播感染、生殖健康和计划生育的健康服务。这是该国针对高危女性的传播最广泛的艾滋病毒项目，据估计，在全国3.5万名从事娱乐工作的女性中，有超过三分之一的人与之有过接触。使用阶梯式楔形随机整群试验，我们将评估我们建议的聪明女孩+计划是否会比标准的聪明女孩更大程度地降低艾滋病毒风险。该计划在10个省实施了30个月。干预措施包括培训和实施针对聪明女孩平台内的安非他明类兴奋剂用户的有条件现金转移方案(CCT)，以及将符合条件的妇女转介到小额信贷组织进行财务培训和资源。不使用安非他明类兴奋剂的妇女(有条件现金转移和非有条件现金转移计划客户)将有资格被转介到小额信贷组织。这项申请的第二个目标是在柬埔寨建立艾滋病毒执行科学合作组织(HISC)。HISC将联系一系列政府、学术和社区利益攸关方，这些利益攸关方来自我们的组织与柬埔寨艾滋病毒预防和护理组织广泛的历史和当前合作伙伴关系。HISC的使命将是推动柬埔寨艾滋病毒预防研究的翻译方面，包括：(1)就Smart Girl Plus项目提供建议和观点；(2)参与和促进关键的可持续性活动，特别是在新的 实施和传播科学领域；以及(3)参与旨在在柬埔寨和更广泛的国际艾滋病毒预防社区内分享研究和方案成果的方案传播活动。拟议的项目将由一个经验丰富的合作研究小组进行，其中包括来自加州大学旧金山分校、柬埔寨FHI 360大学和澳大利亚新南威尔士大学的合作研究小组。这些小组中的每个小组都在柬埔寨拥有十多年的艾滋病毒预防研究、计划规划和实施方面的经验和专业知识，所有这些都是与该国的其他关键小组合作或共同完成的。拟议的实施科学项目将为柬埔寨的艾滋病毒预防实践带来新的重大知识和潜在的改进。

DESCRIPTION (provided by applicant): In Cambodia, female entertainment and sex workers (FESWs) are one of the highest risk groups for HIV: prevalence and incidence of HIV are high, as is use of non injected amphetamine type stimulant (ATS) use. Our research there has shown that ATS contributes significantly to HIV risk. This proposed research will assess the impact of implementing new combination HIV prevention intervention options (drug abuse prevention and microfinance tools) integrated into an existing HIV prevention program (SMART girl) targeting high risk Cambodian FESWs. SMART girl provides a range of education and outreach services, especially referrals to HIV testing, and health services for sexually transmitted infections, reproductive health and family planning. It is the most widely disseminated HIV program for at risk women in the country, estimated to have contact with over one third of the country's 35,000 women engaged in entertainment work. Using a stepped wedge randomized cluster trial, we will evaluate whether our proposed SMART girl Plus program, implemented in 10 provinces over 30 months, will result in larger decreases in HIV risk compared to standard SMART girl. The intervention consists of training for and implementation of a conditional cash transfer program (CCT) aimed at ATS users within the SMART girl platform, and referrals of eligible women to a microfinance organization for financial training and resources. Women who do not use ATS (CCT and non- CCT program clients) will be eligible for referral to the microfinance organization. A second goal of this application entails the creation of an HIV Implementation Science Collaborative (HISC) in Cambodia. The HISC will link a range of governmental, academic and community-based stakeholders drawn from our groups' extensive historic and current partnerships with HIV prevention and care groups in Cambodia. The HISC mission will be to advance translational aspects of HIV prevention research in Cambodia, including by (1) providing advice and perspectives on the SMART girl Plus project; (2) participating in and promoting key sustainability activities, especially training and education opportunities in the new field of Implementation and Dissemination Science; and (3) participate in program dissemination activities aimed at sharing the research and program results within Cambodia and the broader international HIV prevention community. The proposed project will conducted by an experienced collaborative research group including from University of California San Francisco, FHI 360 Cambodia, and from Australia, the University of New South Wales. Each of these groups has over a decade each of experience and expertise in HIV prevention research, program planning and implementation in Cambodia, all in collaboration together or with other key groups in that country. The proposed implementation science project will result in significant new knowledge and potential improvements to HIV prevention practice in Cambodia.