Expanding HIV Testing and Prevention to Reach Vulnerable Young Women

 描述（由申请人提供）：在南非，开普敦弱势社区中使用酒精和其他药物（AOD）并已辍学的弱势女性青少年面临新的艾滋病毒感染的最大负担。感染艾滋病毒的风险是通过使用AOD、性别不平等、性风险、受害、计划外怀孕和帮派暴力等交叉因素持续存在的。尽管艾滋病毒的普遍传播，这一弱势群体仍然没有得到当前艾滋病毒和药物治疗方案的充分服务，很少有提供艾滋病毒检测和咨询（HTC），产前护理或药物滥用康复，没有提供全面的HTC方案，解决这些交叉风险的艾滋病毒在这一人群中。自2001年以来，我们已经调整并开展了一项针对妇女的综合循证干预措施，即妇女健康合作社，该合作社解决了AOD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援署《非洲性别研究简编》。青年妇女合作方案是对妇女保健方案的一种调整，其目标是利用少女为这一脆弱的非洲发展中国家人口服务。这一拟议的外地住房储备金项目力求接触到这一难以接触到的人群，并克服障碍，改善辍学少女的健康状况，方法是通过由来自每个社区的训练有素的同伴共同促进者和外展工作者进行以性别为重点的综合干预，不断更新辍学少女健康状况。研究结果可能提供的知识，可用于增加服务的吸收，并通过使用同伴驱动的干预方法，提高少女的治疗依从性。具体目标：我们的具体目标包括以下内容。在南非开普敦的12个弱势社区进行的一项随机分组试验中，我们与政府合作，提出了以下建议：目标1。培训和评估青少年同伴榜样，与已建立的外展工作人员一起开展社区外展活动，为戒毒中心招募500名15-19岁的校外吸毒女青少年，并共同促进以性别为重点的综合戒毒中心方案。目标2.测试一个年轻妇女的性别为重点的综合HTC方案的有效性，以减少药物使用，受害，性风险行为（主要成果），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成果）的联系，改善获得有效的治疗和支持服务相对于标准HTC的青春期女性。这项研究与西开普省社会发展部和开普敦市的合作也将使受过培训的同行能够进行外展，并共同促进社区中心内的干预，这将很可能确保最需要的地方更大的可持续性。

 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.