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

描述（由申请人提供）：本研究的总体目的是减少风险行为，提高处于不利地位的吸毒农村妇女对艾滋病毒和丙型肝炎病毒高风险的健康和行为健康服务的利用。该项目有可能作出重大贡献的科学，通过推进知识的健康差距，高风险行为（注射吸毒，性风险），并利用这一高风险，脆弱的，一个未充分研究的妇女群体在阿巴拉契亚农村地区的新兴和重大的公共卫生风险的时间。该项目将纳入标准化筛查（国家药物滥用局修订的ASSIST），以查明监狱中的高风险农村妇女吸毒者，包括注射者。接受艾滋病教育的妇女（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）艾滋病教育（艾滋病毒-艾德，n=175），其中包括NIDA标准的测试前和测试后咨询，艾滋病毒和丙型肝炎病毒快速检测，以及关于现有社区药物滥用和艾滋病毒/丙型肝炎病毒资源的信息包;或（2）基于动机访谈的艾滋病毒风险降低（MI-HIV n=175），除了在HIV-Ed组中接受的治疗外，还包括一个基于证据的简短干预，风险妇女侧重于制定个性化计划，以增强减少风险行为和利用社区保健和行为保健服务的动力。具体目标包括：（1）比较以证据为基础的减少艾滋病毒风险干预措施（MI-HIV）与艾滋病毒教育的有效性（NIDA标准）在减少性风险行为、注射做法和吸毒方面的作用，这些行为是在文化上独特的弱势、吸毒的艾滋病毒和丙型肝炎高风险农村妇女样本中进行的;以及（2）检验MI-HIV干预参与作为社区卫生和行为卫生服务利用的预测因子（包括药物治疗和精神健康）的后续行动。该项目具有创新性，因为它1）针对高风险和未充分研究的女性群体，2）使用简短的干预措施不仅减少风险行为，还提高了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风险女性吸毒者。这项研究的长期目标是增加获得保健和行为保健服务的机会，以提高高危农村妇女的健康质量。 公共卫生相关性：本研究的总体目标是减少危险行为，提高健康和行为卫生服务的利用率，处于不利地位的，吸毒的艾滋病毒和丙型肝炎病毒的高风险农村妇女。该项目有可能通过提供有关健康，风险行为和服务利用的一个脆弱和未充分研究的妇女群体在一个农村阿巴拉契亚地区的新出现的和重大的公共卫生风险的时候，科学作出重大贡献。圆满完成各项目标 该项目将推动提供一种低成本、潜在高影响的干预措施，并对其他一些真实的世界环境（如刑事司法场所）产生影响，在这些环境中，可以查明其他处境不利的高风险吸毒者并将其作为干预对象。

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.