Case Management Alternatives for African American Women at High Risk for HIV

描述(申请人提供)：项目描述。这项申请是NI DA补助金#R01 DA13131的竞争性续签，“针对吸毒女性性工作者的简要艾滋病毒/丙型肝炎/乙肝干预措施”。这项研究的一项重要发现是，贫穷的街头女性性工作者所经历的一些因素--包括童年创伤、吸毒、无家可归、街头生活、强奸和暴力受害--导致了这一群体的严重健康问题。这些对迈阿密的非裔美国妇女来说最为关键，因为她们的经济资源水平较低，她们所在的迈阿密最贫穷和最被忽视的社区，以及她们较高的艾滋病毒和其他性传播感染(STI)比率。尽管这些妇女面临着无数的健康和社会问题，但许多障碍阻碍了她们寻求和获得所需服务。这一竞争性更新的目的是测试旨在加强与药物滥用、治疗和其他保健服务的联系和参与的创新办法，这些服务得不到充分服务。拟议申请的具体目标是：1)评估从迈阿密市中心市中心社区招募的550名涉及毒品、贫困的非裔美国妇女的样本中，卫生服务需求的性质和程度以及服务利用的障碍；2)实施两种替代病例管理条件，旨在通过随机分配参与者来增加与适当卫生服务的联系和对适当卫生服务的利用：仅限特长/专业人员的条件，在该条件下，客户参与“基于特长”的病例管理方法；或者，一种基于优势的/专业/同伴条件，即由以下人员组成的团队：a)一名有资格证书的专业案件管理人和b)一名正在康复的吸毒者/前性工作者同伴--两人都接受过“基于能力”的案例管理技术培训--制定并促进服务计划的实施；3)通过与客户和提供者进行3个月和6个月的跟踪，评估这两种条件的有效性，以确定服务联系的程度和服务利用的结果，以及与服务获得有关的危险行为的变化；以及，4)在这两种情况下，评估诱因、促成因素和疾病/需要因素之间的相互作用模式，并在后续检查它们对服务联系和参与的影响。与公共卫生的相关性。建立一种有效的机制，满足使用毒品的贫困非裔美国性工作者的健康和服务需求，将改善目标人口的健康状况和生活质量。此外，由于性工作者与多个性伴侣有接触，测试治疗和服务联系的创新方法的研究在避免新的艾滋病毒/性传播感染方面有好处，为已经感染的人提供更早的医疗机会，并减少这些感染向更广泛的人群传播。

DESCRIPTION (provided by applicant): Project Description. This application is a competing renewal of NI DA Grant # R01 DA13131, "Brief HIV/HCV/HBV Interventions for Drug-Using Women Sex Workers." An important finding of this study was that a number of factors experienced by indigent, street-based, women sex workers - including childhood trauma, drug use, homelessness, street life, rape and violent victimization -- contribute to serious health problems among this population. These are most critical among African-American women in Miami, given their lower levels of economic resources, their location in Miami's most impoverished and neglected communities, as well as their higher rates of HIV and other sexually transmitted infections (STIs). In spite of the myriad of health and social problems among these women, numerous barriers prevent them from seeking and accessing needed services. The purpose of this competing renewal is to test innovative approaches designed to increase linkages and engagement with drug abuse treatment and other health services among this underserved population. The specific aims of the proposed application are to: 1) assess the nature and extent of health service needs and barriers to service utilization among a sample of 550 drug-involved, indigent, African-American women recruited from inner city neighborhoods in downtown Miami; 2) implement two alternative case management conditions designed to increase linkages to, and utilization of, appropriate health services by randomly assigning participants to: a Strengths-Based / Professional Only Condition in which clients participate in a "strengths-based" case management approach; or, a Strengths-Based / Professional/Peer Condition in which a team composed of: a) a credentialed, professional case manager and b) a recovering addict/former sex worker-peer - both trained in "strengths-based" case management techniques - develop and facilitate the implementation of a service plan; 3) evaluate the effectiveness of these two conditions by conducting 3 and 6-month follow-ups with both clients and providers to determine extent of service linkages and outcomes of service utilization, as well as changes in risk behaviors as they relate to service access; and, 4) both across and between the two conditions, assess the patterns of interaction among predisposing, enabling, and illness/need factors, and examine their effects on services linkage and engagement at follow-up. Relevance to Public Health. Developing an effective mechanism for addressing the health and service needs of indigent drug-using African-American sex workers will improve the health status and the quality of life of the target population. In addition, because sex workers have contacts with multiple sexual partners, research that tests innovative approaches to treatment and service linkage has a benefit in terms of avoiding new HIV/STI infections, providing earlier access to medical treatment for those already infected, and reducing the spread of these infections to a wider population.