Expanding HIV Testing and Prevention to Reach Vulnerable Young Women

 描述(由申请人提供)：开普敦弱势社区中使用酒精和其他药物(AOD)并辍学的弱势女性青少年在南非经历了新的艾滋病毒感染的最大负担。感染艾滋病毒的风险通过使用AOD、性别不平等、性风险、受害、意外怀孕和帮派暴力等交叉因素长期存在。尽管艾滋病毒正在广泛传播，但目前的艾滋病毒和药物治疗方案仍然没有为这一弱势群体提供足够的服务，很少有人提供艾滋病毒检测和咨询(HTC)、产前护理或药物滥用康复，也没有人提供全面的HTC方案来解决这一人群中艾滋病毒的这些交叉风险。自2001年以来，我们调整并实施了一项针对妇女的全面循证干预措施--妇女健康合作(WHC)，以解决AOD的使用、性风险和基于性别的暴力问题。世界遗产中心被列入美国国际开发署《非洲性别研究简编》。青年妇女鸡舍(YWC)是对世界卫生中心的改编，针对AOD的弱势群体，使用女性青少年。这一拟议的RFA项目旨在接触到这一难以接触到的人群，并克服障碍，通过与来自每个社区的训练有素的同行共同协调人和外展工作人员一起，通过全面的以性别为重点的HTC干预，增加HTC的更新，从而改善辍学女性青少年的健康状况。研究结果可能会提供知识，可用于通过使用同伴驱动的干预方法，增加对服务的接受，并改善女性青少年对治疗的依从性。具体目标：我们的具体目标包括以下几个方面。在南非开普敦12个弱势社区进行的一项整群随机试验中，我们建议：目标1.培训和评估青少年同伴榜样，与现有的外展工作者进行社区外联，为HTC招募500名校外、吸毒的女性青少年，并共同促进以性别为重点的综合HTC计划。目的2.与青春期女性标准HTC相比，测试年轻女性以性别为重点的综合性HTC方案的有效性，该方案旨在减少药物使用、受害和性危险行为(主要结果)，并通过与护理(药物滥用治疗、艾滋病毒、性传播感染、产前和生殖健康作为次要结果)的联系，改善获得有效治疗和支持服务的机会。这项研究与西开普省社会发展部和开普敦市政府的合作也将使接受过培训的同龄人能够在社区中心内开展外联和共同促进干预，这很可能确保在最需要干预的地方实现更大的可持续性。

 DESCRIPTION (provided by applicant): Vulnerable female adolescents in disadvantaged communities in Cape Town who use alcohol and other drugs (AOD) and have dropped out of school experience the greatest burden of new HIV infections in South Africa. The risk for acquiring HIV is perpetuated through intersecting factors of AOD use, gender inequality, sexual risk, victimization, unplanned pregnancy, and gang violence. Despite the pervasive ongoing transmission of HIV, this vulnerable population remains underserved by current HIV and drug treatment programs, with few providing HIV testing and counselling (HTC), antenatal care, or substance abuse rehabilitation, and none providing comprehensive HTC programs that address these intersecting risks for HIV among this population. Since 2001, we have adapted and conducted a comprehensive evidence-based intervention for women, the Women's Health CoOp (WHC), that addresses AOD use, sexual risk, and gender-based violence. The WHC was listed in the USAID Compendium of Gender Studies in Africa. The Young Women's CoOp (YWC) is an adaptation of the WHC that targets this vulnerable population of AOD using female adolescents. This proposed RFA project seeks to reach this hard-to-reach population and overcome barriers to improved health for female adolescents who have dropped out of school by increasing update of HTC through a comprehensive gender-focused HTC intervention with trained peer co-facilitators and outreach workers from each community. The study findings may provide knowledge that could be used to increase the uptake of services and improve treatment adherence among female adolescents through the use of peer-driven intervention methods. Specific Aims: Our specific aims including the following. In a cluster randomized trial conducted in 12 disadvantaged communities in Cape Town, South Africa, and with government collaboration, we propose: Aim 1. To train and evaluate adolescent peer role models to conduct community outreach with established outreach workers to recruit 500 out-of schools, substance-using female adolescents aged 15-19 for HTC, and to co-facilitate a gender-focused comprehensive HTC program. Aim 2. To test the efficacy of a young women's gender-focused comprehensive HTC program for reducing substance use, victimization, and sexual risk behavior (primary outcomes) and improving access to effective treatment and support services through linkages to care (substance abuse treatment, HIV, STIs, antenatal and reproductive health as secondary outcomes) relative to standard HTC for adolescent females. This study's collaboration with the Western Cape-Department of Social Development and the City of Cape Town will also empower peers trained to conduct outreach and co-facilitate the intervention within community centers will most likely ensure greater sustainability where it is needed most.