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Resubmission: Multilevel Strategies & Tailored HIV Prevention & Care for Young Couples who use Alcohol & Other Drugs Across Cape Town

重新提交：多层次策略

基本信息

批准号：
10401928
负责人：
Felicia Amira Browne
金额：
$ 69万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10401928
关键词：
AIDS prevention Address Adherence Age-Years Alcohol consumption Arts Attitude Behavior Behavior Therapy Caring Catchment Area Clinic Cluster randomized trial Communication Communities Continuity of Patient Care Couples Discrimination Drug usage Economically Deprived Population Ensure Epidemic Fright Gender Gender Role Goals Government HIV HIV Infections HIV antiretroviral Health Health Policy Health Services Accessibility Heterosexuals Human immunodeficiency virus test Impairment Incidence Individual Intervention Knowledge Learning Longevity Mediation Methods National Institute of Drug Abuse Oral Outcome Persons Pharmaceutical Preparations Phase Prevalence Prevention Public Health Randomized Reporting Reproductive Health Services Risk Risk Behaviors Service provision Services Sexual Health Sexual Partners South Africa Staff Attitudes Stigmatization Testing Training United States Unsafe Sex Viremia Virus Woman aged alcohol and other drug antiretroviral therapy biobehavior burden of illness condoms critical period design effective intervention efficacy testing empowered empowerment evidence base frontier gender-based violence improved male novel strategies peer pre-exposure prophylaxis prevent programs sex risk sexual risk behavior sexually active skills social stigma syndemic testing services transmission process uptake young adult young woman

项目摘要

PROJECT SUMMARY/ABSTRACT The highest HIV incidence in South Africa is among young women, many of whom are in relationships with a primary partner in which alcohol and other drug (AOD) use is common between them, in addition to condomless sex, outside sex partners, and gender-based violence (GBV). Many young women and their partners are in young adulthood, a critical period characterized by sexual risk. The proposed revised comprehensive prevention and treatment approach is needed to address these intersectional epidemics. We propose to modify our evidence-based couples' intervention for young couples in Cape Town. The proposed Couples' Health CoOp Plus (CHC+) biobehavioral intervention will include information about and linkage to PrEP and ART. We also will refine a stigma-reduction training for clinics to address stigmatizing attitudes and behaviors toward young people who use AODs and seek HIV services. We propose a multilevel approach through a cluster randomized trial with a modified factorial design whereby 24 clinics are randomized to receive either stigma-reduction training or no training. From the clinic catchment areas in economically disadvantaged communities, we will use NIDA's Seek, Test, Treat and Retain paradigm to seek 480 couples (aged 18 to 30). Clinics in catchment areas will be randomized to receive HIV testing services (HTS) and/or the CHC+. An earlier study demonstrated the efficacy of the couples' intervention on AOD use, sex risk, gender roles and HIV incidence, but it did not incorporate ART and PrEP (treat); nor was it integrated into clinics to address stigma in service provision (treat and retain). The Specific Aims are: Aim 1. To modify the CHC intervention to include ART/PrEP in a formative phase and with review from our Community Collaborative Board and a Peer Advisory Board. Aim 2. To evaluate the impact of a stigma-reduction training on clinic staffs' attitudes and behaviors toward young women and their primary male partner seeking HIV services (testing/ART/PrEP) and other sexual and reproductive health services with clinic staff at 6 and 12 months. Aim 3. To test the efficacy of the CHC+ to increase both partners' PrEP/ART initiation and adherence (at 3, 6, 9, and 12 months), and reduce AOD use, sexual risk and GBV, and enhance positive gender norms and communication relative to HTS (at 6 and 12 months). Aim 4. To examine through mixed methods the interaction of the stigma-reduction training and the CHC+ on increased PrEP and ART initiation, retention, and adherence among young women and their primary partners. If this multilevel approach demonstrates efficacy in increasing PrEP and ART initiation, adherence and retention, it could help achieve the Undetectable=Untransmittable (U=U) goals. If successful, the project could help the governments of South Africa and the United States identify new approaches to expanding the HIV continuum of prevention and care among young couples at risk for HIV.

项目总结/文摘