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

项目摘要/摘要 南非艾滋病毒感染率最高的是年轻女性，她们中的许多人与 主要伴侣，其中酒精和其他药物(AOD)的使用在他们之间很常见，除了 无公寓性行为、外部性伴侣和基于性别的暴力(GBV)。许多年轻女性和她们 伴侣正处于青壮年，这是一个以性风险为特征的关键时期。建议修订的 需要采取全面的预防和治疗办法来应对这些跨部门流行病。我们 建议修改我们对开普敦年轻夫妇的循证夫妇干预。 拟议的夫妇健康合作伙伴(CHC+)生物行为干预将包括以下信息 以及与PrEP和ART的联系。我们还将为诊所改进减少污名的培训，以解决 污名化对使用AOD和寻求艾滋病毒服务的年轻人的态度和行为。我们 通过采用改进的析因设计的整群随机试验，提出一种多水平的方法 诊所被随机分为两组，要么接受减少污名的培训，要么不接受培训。从诊所的集水区 在经济困难社区的地区，我们将使用NIDA的搜索、测试、治疗和保留 研究对象为480对夫妻(年龄在18至30岁之间)。集水区的诊所将随机接受艾滋病毒感染 测试服务(HTS)和/或CHC+。早些时候的一项研究证明了这些夫妇的疗效 对AOD使用、性风险、性别角色和艾滋病毒发病率的干预，但没有纳入ART和PrEP (治疗)；它也没有纳入诊所，以解决服务提供中的污名问题(治疗和保留)。 具体目标是：目标1.修改CHC干预措施，将ART/PrEP纳入形成阶段 并经过我们的社区合作委员会和同行咨询委员会的审查。目标2.评估 减少污名培训对诊所工作人员对待年轻女性和青少年的态度和行为的影响 他们的主要男性伴侣寻求艾滋病毒服务(检测/抗逆转录病毒治疗/预防艾滋病)和其他性服务和生殖服务 与6个月和12个月的诊所工作人员一起提供卫生服务。目的3.测试CHC+对提高两种疾病的疗效 性伴侣的PrEP/ART开始和坚持(在3、6、9和12个月)，并减少AOD的使用、性风险 和GBV，并加强与HTS相关的积极的性别规范和沟通(6个月和12个月)。 目的4.通过混合方法考察减少污名训练与CHC+-ON的相互作用 增加PrEP和ART的启动、保留和对年轻女性及其主要女性的坚持 合伙人。 如果这种多层次的方法在增加PrEP和ART启蒙方面表现出有效性，那么坚持和 保留，它可以帮助实现不可检测=不可传播(U=U)的目标。如果成功，该项目将 可以帮助南非和美国政府确定扩大 在有艾滋病毒风险的年轻夫妇中，预防和护理艾滋病毒的连续体。

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.