Expanding HIV Testing and Prevention to Reach Vulnerable Young Women

扩大艾滋病毒检测和预防范围，惠及弱势年轻女性

• 批准号: 9312784
• 负责人: WENDEE M WECHSBERG
• 金额: $ 32.61万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9312784
• 关键词: 19 year old; AIDS prevention; AIDS/HIV problem; Address; Adolescent; Africa; Age-Years; Alcohol consumption; Alcohol or Other Drugs use; Behavioral; Belief; Biological; Caring; Cities; Cluster randomized trial; Collaborations; Communities; Community Outreach; Counseling; Country; Diagnosis; Disadvantaged; Drug usage; Ensure; Evidence based intervention; Female; Female Adolescents; Financial Support; Focus Groups; Fright; Gender; Goals; Government; HIV; HIV Infections; HIV/STD; Health; Health Services; Human immunodeficiency virus test; Improve Access; Incidence; Inequality; Intervention; Interview; Knowledge; Learning; Letters; Methods; Monitor; Neighborhoods; Outcome; Participant; Pharmaceutical Preparations; Pharmacotherapy; Population; Pregnancy; Pregnancy in Adolescence; Prevalence; Process; Provider; Public Health; Randomized; Recruitment Activity; Reproductive Health; Risk; Risk Behaviors; Risk Factors; Risk Reduction; School Drop-Outs; Schools; Science; Services; Side; Social Development; South Africa; Student Dropouts; Target Populations; Testing; Training; Treatment Efficacy; USAID; Unemployment; Update; Victimization; Violence; Visit; Vulnerable Populations; Woman; Women' s Health; Work; aged; alcohol and other drug; antenatal; community center; effective therapy; efficacy testing; evidence base; experience; follow-up; gang; gang violence; gender difference; gender-based violence; health seeking behavior; improved; innovation; men; motherhood; neighborhood disadvantage; outreach; peer; peer coaching; peer support; post intervention; primary outcome; programs; public health relevance; reduced substance use; response; role model; secondary outcome; sex risk; sexually active; skills; social stigma; substance abuse rehabilitation; substance abuse treatment; substance using adolescents; transmission process; treatment adherence; treatment program; unintended pregnancy; uptake; vulnerable adolescent; young man; young woman

 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.

 描述（由申请人提供）：南非开普敦弱势社区中酗酒和吸毒（AOD）并辍学的弱势女性青少年承受着南非新增艾滋病毒感染的最大负担。感染艾滋病毒的风险因 AOD 使用、性别不平等、性风险、受害、意外怀孕和帮派暴力等交叉因素而长期存在。尽管艾滋病毒正在普遍传播，但目前的艾滋病毒和药物治疗计划仍然未能为这一弱势群体提供服务，很少有机构提供艾滋病毒检测和咨询（HTC）、产前护理或药物滥用康复服务，也没有机构提供全面的 HTC 计划来解决该人群中艾滋病毒的交叉风险。自 2001 年以来，我们针对女性调整并实施了一项全面的循证干预措施，即妇女健康合作社 (WHC)，该干预措施旨在解决 AOD 的使用、性风险和基于性别的暴力问题。 WHC 被列入美国国际开发署非洲性别研究纲要。青年女性合作社 (YWC) 是 WHC 的改编版，针对使用女性青少年的 AOD 弱势群体。拟议的 RFA 项目旨在通过与来自每个社区的训练有素的同伴共同协调员和外展工作人员进行全面的以性别为中心的 HTC 干预措施，增加 HTC 的更新，从而接触到这一难以接触到的人群，并克服改善辍学女性青少年健康的障碍。研究结果可能提供知识，可用于通过使用同伴驱动的干预方法来增加女性青少年对服务的接受并提高治疗依从性。具体目标：我们的具体目标包括以下内容。在南非开普敦 12 个弱势社区进行的一项整群随机试验中，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，与既定的外展工作人员一起开展社区外展活动，招募 500 名 15-19 岁的校外、使用药物的女性青少年参加 HTC，并共同促进以性别为中心的综合 HTC 计划。目标 2. 测试年轻女性以性别为中心的综合 HTC 方案相对于青少年女性标准 HTC 的效果，该方案在减少药物使用、受害和性危险行为（主要成果）以及通过与护理（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治疗和支持服务的机会方面的效果。这项研究与西开普省社会发展部和开普敦市的合作还将授权受过培训的同行进行外展活动并共同促进社区中心内的干预措施，这将很可能确保在最需要的地方实现更大的可持续性。