A structural HIV prevention intervention targeting high-risk women

项目摘要 在艾滋病毒流行30年后，世界各地的性工作者中艾滋病毒/性传播感染比率居高不下， 而在美国，对这一群体的研究却很少。FSWs经历了一组独特的漏洞 与污名和不安全的工作环境等结构性因素有关。这些因素抑制了 保护性行为和寻求艾滋病毒检测、护理和治疗。预防艾滋病毒的方法 解决暗娼感染艾滋病毒的社会和结构脆弱性问题已显示出成效 全世界。然而，在美国，结构性艾滋病毒预防干预措施很少。我们的研究发现 广泛的结构性脆弱性，如高无家可归率、饥饿率和暴力率，以及 街头暗娼注射和非注射毒品使用率。我们现在是“A”的第四个年头 针对高危妇女的结构性艾滋病毒预防干预措施“(R01DA041243)--”Emerald“研究-- 它的重点是制定和评估独特和创新的结构性干预措施，旨在减少 艾滋病病毒、性传播感染和FSW中有问题的药物使用的负担。我们正在请求补充以支持 翡翠队列招聘和后续行动的实际和预计费用。简而言之，招聘和 与我们之前在FSW中进行的研究相比，保留费用显著高于预期 巴尔的摩。目前，研究人群已被证明较难接触和跟踪- 这需要我们的外地工作人员投入更多的时间和精力。此外，致命的服药过量比率在 巴尔的摩，与当地和全国的阿片类药物流行一致，正在影响我们的研究人群和 样本。该副刊的目的如下。第一，实现持续扩张(350至385名妇女) 并对Emerald队列进行跟踪，以充分检查暴露于干预的影响(SPARC 关于艾滋病毒/性传播感染危险行为(如吸毒/无保护措施的性行为)的构成部分，以及艾滋病毒/性传播感染累计情况 干预组(n=225)暗娼随时间变化的发病率与对照组的比较 160例。其次，检验Emerald队列中非致命性和致命性过量用药的相关性(N=385) 由于阿片类药物流行，致命性和非致命性过量服药率高于预期。通过AIM 1， 所要求的补充资料将使我们既可以扩大样本，又可以加强对 考虑到需要更多工作人员的密集努力，总的研究样本。AIM 2将允许一个强大的 了解非致命性和致命性过量死亡，检查患病率、发病率、相关性、 以及自我报告的非致命和确认的致命过量的预测因子，后者通过 来自国家卫生统计中心的国家死亡指数。

Project Summary Three decades into the HIV epidemic, high HIV/STI rates persist among FSWs throughout the world, and research on this population in the U.S. is scarce. FSWs experience a unique set of vulnerabilities associated with structural factors such stigma, and unsafe work environments. These factors inhibit protective sexual behaviors and seeking of HIV testing, care, and treatment. HIV prevention approaches that address social and structural vulnerabilities to HIV infection among FSWs have demonstrated effectiveness worldwide. Yet in the U.S., structural HIV prevention interventions are scarce. Our research has found extensive structural vulnerability such as high rates of homelessness, hunger, and violence, as well as high rates of injection and noninjection drug use among street-based FSWs. We are currently in the 4th year of “A structural HIV prevention intervention targeting high-risk women” (R01DA041243) – the “EMERALD” study - that focuses on developing and evaluating a unique and innovative structural intervention aimed to reduce the burden of HIV, STIs, and problematic drug use among FSW. We are requesting a supplement to support the actual and projected cost of the EMERALD cohort recruitment and follow-up. Briefly, recruitment and retention expenses are significantly higher than anticipated compared to our prior studies among FSW in Baltimore. At the current, time, the study population have proved to be less accessible to reach and to follow- up, which requires more time and effort from our field staff. Further, increasing rates of fatal overdose in Baltimore, consistent with the local and national opioid epidemic, are impacting our study population and sample. The supplement’s aims are the following. First, to enable continued expansion (350 to 385 women) and follow-up the EMERALD cohort to sufficiently examine the effect of exposure to intervention (SPARC Center) components on HIV/STI risk behaviors (e.g., drug use/unprotected sex), and HIV/STI cumulative incidence over time in FSWs in the intervention group (n=225) compared to those in the comparison group (n=160). Secondly, to examine correlates of nonfatal and fatal overdose in the EMERALD cohort (N=385) given higher than anticipated fatal and nonfatal overdose rates owing to the opioid epidemic. Through Aim 1, the requested supplement will allow us to both expand our sample as well as intensify follow-up efforts for the total study sample given the need for more staff intensive up efforts. Aim 2 will allow for a robust understanding of both nonfatal and fatal overdose deaths, examining the prevalence, incidence, correlates, and predictors of both self-reported nonfatal and confirmed fatal overdoses, the latter of which through the National Death Index from the National Center of Health Statistics.