Using CBPR to Engage Hazardous Drinking Women in the HIV Prevention and Care Continuum

在美国，女性占艾滋病毒携带者(PLWH)的四分之一，而非裔美国人(AA) 女性只占美国女性人口的14%，她们占女性生活的60%以上 艾滋病毒携带者(WLWH)。2013年，马里兰州的艾滋病毒感染率仅次于华盛顿特区 在女性中的诊断。酒精滥用中断了艾滋病毒预防和护理连续过程中的关键步骤 (HPACC)，因此在高危人群和WLWH人群中造成了巨大的健康差距。我们之前的工作是 巴尔的摩已经证明酗酒与艾滋病危险行为之间存在很强的相关性。 风险和WLWH，在艾滋病毒护理中保留较差，以及较少使用和坚持抗逆转录病毒治疗(ART)。 我们已经开发了基于理论、面对面和计算机提供的简短干预(CBI)，以应对风险和 WLWH与酒精滥用有关，表明在最近的随机对照试验中饮酒减少。然而，行为和 酒精干预措施的最佳摄取和参与HPACC的结构性障碍仍然存在，包括 精神健康合并症以及对艾滋病毒预防做法的了解、获取和使用不足，如艾滋病毒感染前 暴露预防(PrEP)。吸引关键利益相关者参与，包括高危和WLWH，以及社区 组织和领导人，对于在艾滋病毒的交汇点成功实施干预措施至关重要 以及女性滥用酒精的问题。这项提议的目标有两个：1)在我们现有的基础上 社区伙伴关系，以确定如何以最佳方式为高危人群实施基于证据的酒精治疗 和巴尔的摩的WLWH，以及2)确定信息的添加、激励和同伴 与共病心理健康相关的导航员支持，以及艾滋病毒预防做法可以增强CBI和 改善高危人群和WLWH人群的酒精和HPACC结果。为了实现这些目标，我们将使用 基于社区的参与性研究(CBPR)方法，吸引患者和社区利益相关者参与 在研究开发的各个方面，以及社区试点测试期间。与我们的社区合作 咨询委员会(CAB)，我们将：1)用短信调整我们目前的CBI，以填补艾滋病毒中的空白 预防和护理连续体(CBI-CC)。我们将引导风险和WLWH的焦点小组进行量身定做 干预手册，随后进行试点以及进一步的反馈和修改。2)我们将进行试点 在60名高危或WLWH患者中进行CBI-CC+文本和同伴导航的随机对照试验(RCT) 酗酒。在3个月和6个月时评估的主要结果包括饮酒天数，重度饮酒天数， 每天饮酒；其他结果包括不使用避孕套的性行为、精神健康和物质 使用治疗参与性和接受艾滋病毒预防做法(艾滋病毒检测、PrEP、避孕套)。通过 这笔U34规划赠款将与社区中的主要利益相关者合作，以建设交付 在酒精与艾滋病毒的结合点对高危人群和WLWH进行有效的循证干预 减少滥用，并加强对艾滋病毒预防和护理连续体的参与。

Women account for 1 in 4 people living with HIV (PLWH) in the United States, and while African American (AA) women comprise only 14% of the US female population, they account for greater than 60% of women living with HIV (WLWH). In 2013, the state of Maryland was second only to Washington, DC in the rates of HIV diagnoses among women. Alcohol misuse interrupts critical steps in the HIV prevention and care continuum (HPACC) and thus contributes to significant health disparities among at-risk and WLWH. Our prior work in Baltimore has demonstrated a strong association between alcohol misuse and HIV risk behaviors among at risk and WLWH, poorer retention in HIV care and lower use of and adherence to antiretroviral therapy (ART). We have developed theory-based, in-person and computer-delivered brief interventions (CBI) for at risk and WLWH with alcohol misuse, demonstrating drinking reductions in recent RCTs. However behavioral and structural barriers to optimal uptake of alcohol interventions and engagement in the HPACC remain, including mental health comorbidity and low knowledge, access, and use of HIV prevention practices such as HIV pre- exposure prophylaxis (PrEP). Engaging key stakeholders, including at-risk and WLWH, and community organizations and leaders, is critical to successful implementation of interventions at the intersection of HIV and alcohol misuse among women. The goals of this proposal are two-fold: 1) to build on our current community partnerships to determine how to optimally implement evidence based alcohol treatment for at risk and WLWH in Baltimore, and 2) to determine whether the addition of information, motivational and peer navigator support related to comorbid mental health, and HIV prevention practices can enhance CBI and improve alcohol and HPACC outcomes among at risk and WLWH. To achieve these goals we will use a Community Based Participatory Research (CBPR) approach, engaging patient and community stakeholders during all aspects of study development, and community pilot testing. In collaboration with our Community Advisory Board (CAB), we will: 1) adapt our current CBI with text messaging to address gaps in the HIV prevention and care continuum (CBI-CC). We will conduct focus groups with both at risk and WLWH to tailor intervention manuals, followed by piloting and further feedback and modification. 2) We will conduct a pilot randomized controlled trial (RCT) of CBI-CC + text and peer navigation among 60 at-risk or WLWH with alcohol misuse. Primary outcomes, assessed at 3 and 6 months, include drinking days, heavy drinking days, drinks per drinking day; other outcomes include days of sex without condom use, mental health and substance use treatment engagement, and uptake of HIV prevention practices (HIV testing, PrEP, condoms).Through this U34 planning grant we will partner with key stakeholders in the community to build capacity to deliver effective, evidence-based interventions at the nexus of alcohol and HIV for at risk and WLWH with alcohol misuse, and improve engagement in the HIV prevention and care continuum.