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

项目总结/文摘

PROJECT SUMMARY/ABSTRACT The proposed supplement seeks to address barriers and test new facilitators for recruitment and uptake of PrEP and ART for the biobehavioral Couples Health CoOp Plus (CHC+) intervention, and for the stigma- reduction intervention at the structural level within communities. It is critical to note that the CHC+ parent study stigma intervention was originally awarded to take place in community clinics and has shifted to communities due to the COVID pandemic. With these changes, the CHC+ parent study is delayed as the project faces multiple daily barriers with recruitment that slow study progress, including documented community violence, protests, gang violence, and community unrest. The CHC+ team is also adjusting to continuous rolling power outages, which include not only electricity supply but also increased travel time caused by traffic lights being out, and reduced communication with participants caused by mobile network coverage blackouts. Additionally, there are continued high rates of substance use—including heavy alcohol, methamphetamine, and methaqualone with marijuana use—as documented in our preliminary behavioral and biological data. Supplement Goals: Through this supplement, we will aim to better define the community barriers for recruitment and retention. We will also develop strategies to reduce these barriers and increase facilitators for recruitment and retention, and to test them. Consequently, we propose a combination of supplementary approaches, including an environmental scan through police reports, daily reports from staff, in-depth interviews, and focus group discussions with community members; and then to test these new strategies for successful study completion. The proposed Supplement Specific Aims are: Aim 1. To examine how a constellation of violence, drug use patterns, and changes in structural conditions act as barriers to enrollment, intervention engagement, and retention of the couples and community members within each study community. Aim 2. To implement and test peer navigators as facilitators to reduce barriers to recruitment and engagement in both the CHC+ and Community Stigma reduction interventions and complete follow-up appointments successfully. Public Health Impact: The COVID pandemic has challenged and complicated the commitment to end HIV. The loss of jobs, increased community and gang violence, and persistent heavy substance use pose a significant risk for participants in health studies in Cape Town, as do power outages for staff members who are recruiting using community-based approaches. This supplement has the potential to identify solutions and prove that peers can overcome these intersectional barriers and become ambassadors within their communities to safely increase participant recruitment and uptake in health research interventions. There is also the potential to address the HIV care cascade to end HIV and translate these strategies to other regions with more grassroots and sustainable solutions.