Brief intervention for drug-using rural women at high-risk for HIV/HCV

描述(申请人提供)：这项研究的总体目标是减少危险行为，提高弱势、吸毒、艾滋病毒和丙型肝炎高危农村妇女的健康和行为卫生服务利用率。该项目有可能对科学做出重大贡献，通过促进对这一高危、脆弱、未得到充分研究的妇女群体在阿巴拉契亚农村地区新出现的重大公共卫生风险期间的健康差距、高风险行为(注射毒品、性风险)和服务利用的了解。该项目将纳入标准化筛查(NIDA修改的ASSIST)，以识别监狱中的高危农村妇女吸毒者，包括注射器。同意的妇女(N=350)将被要求参加基线访谈，然后被随机分配到两个研究组之一：(1)艾滋病毒教育(HIV-ED n=175)，其中包括NIDA标准的检测前和检测后咨询、艾滋病毒和丙型肝炎快速检测，以及关于现有社区药物滥用和艾滋病毒/丙型肝炎资源的信息包；或(2)以动机访谈为基础的减少艾滋病毒风险(MI-HIV n=175)，除了艾滋病毒-ED组接受的干预外，还包括针对高危妇女的循证短暂干预，重点是增强减少危险行为和在社区使用健康和行为健康服务的动机的个体化计划。具体目标包括：(1)比较循证艾滋病毒降低风险干预(MI-HIV)和艾滋病毒教育(NIDA标准)在减少艾滋病毒和丙型肝炎高危弱势农村妇女中的性危险行为、注射做法和药物使用方面的有效性；以及(2)考察MI-HIV干预参与度作为社区卫生和行为卫生服务利用(包括药物治疗和精神健康)的预测因子在弱势、吸毒高危农村妇女艾滋病毒和丙型肝炎高危人群中的后续预测。该项目具有创新性，因为它1)针对高危和研究不足的女性群体，2)使用简单的干预措施，不仅减少危险行为，而且增强使用社区健康和行为健康资源的动机，3)利用现实世界的环境来识别高危女性吸毒者。这项研究的长期目标是增加获得健康和行为健康服务的机会，以提高农村高危妇女的健康质量。 公共卫生相关性：本研究的总体目标是减少危险行为，提高弱势、吸毒、艾滋病毒和丙型肝炎高危农村妇女的健康和行为卫生服务利用率。该项目有可能为科学做出重大贡献，在阿巴拉契亚农村地区出现重大公共卫生风险的时候，通过提供关于脆弱和未得到充分研究的妇女群体的健康、危险行为和服务利用的知识。圆满完成各项目标 该项目将推进低成本、潜在影响大的干预措施的交付，这将对其他一些现实世界的环境(如刑事司法场所)产生影响，在这些环境中，可以确定其他处于不利地位的高风险吸毒者并将其作为干预的目标。

DESCRIPTION (provided by applicant): The overall aim of this study is to reduce risk behaviors and increase health and behavioral health service utilization among disadvantaged, drug-using rural women at high-risk for HIV and HCV. This project has potential to make a significant contribution to science by advancing knowledge about the health disparities, high-risk behaviors (injection drug use, sex risk), and service utilization of this high-risk, vulnerable, an understudied group of women during a time of emerging and significant public health risk in an Appalachian rural setting. This project will incorporate standardized screening (NIDA-modified ASSIST) to identify high-risk rural women drug users from jails, including injectors. Consenting women (N=350) will be asked to participate in a baseline interview, and will then be randomly assigned to one of two study groups: (1) HIV Education (HIV- Ed n=175) which includes the NIDA standard pre and post-test counseling, HIV and HCV rapid testing, and an information packet on existing community drug abuse and HIV/HCV resources; or (2) Motivational Interviewing- based HIV Risk Reduction (MI-HIV n=175) which, in addition to what is received in the HIV-Ed group, also includes an evidence-based brief intervention for high-risk women focused on an individualized plan for enhancing motivation to reduce risk behaviors and to use health and behavioral health services in the community. Specific aims include: (1) to compare the effectiveness of an evidence-based HIV risk reduction intervention (MI-HIV) to HIV Education (NIDA Standard) in reducing sex risk behaviors, injection practices, and drug use among a culturally unique sample of disadvantaged, drug-using rural women at high-risk for HIV and HCV; and (2) to examine MI-HIV Intervention engagement as a predictor of community health and behavioral health service utilization (including drug treatment and mental health) at follow-up among disadvantaged, drug- using rural women at high risk for HIV and HCV. This project is innovative because it 1) targets a high-risk and understudied group of women, 2) uses brief intervention to not only reduce risk behavior but also to enhance motivation for using community health and behavioral health resources, and 3) utilizes a real-world setting to identify high-risk women drug users. The long-term goal of this study is to increase access to health and behavioral health services in order to improve the quality of health of high-risk rural women. PUBLIC HEALTH RELEVANCE: The overall aim of this study is to reduce risk behaviors and increase health and behavioral health service utilization among disadvantaged, drug-using rural women at high risk for HIV and HCV. This project has potential to make a significant contribution to science by providing knowledge about the health, risk behaviors, and service utilization of a vulnerable and understudied group of women during a time of emerging and significant public health risk in a rural Appalachian setting. Successful completion of the aims of this project will advance the delivery of a low-cost, potentially high impact intervention with implications for a number of other real world settings (such as criminal justice venues) where other disadvantaged high-risk drug users can be identified and targeted for intervention.