Expanding HIV Testing and Prevention to Reach Vulnerable Young Women

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 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.