The Siyaphambili Substance Use Study: Exploring substance use and its treatment in the context of achieving sustained ART adherence among female sex workers

项目摘要/摘要 这个项目的目标是增加对物质使用的理解，它如何影响艾滋病毒护理，以及如何 在关键人群中解决这一问题，南非18岁及以上的女性性工作者(FSW)，使用 来自正在进行的适应性干预Siyaphambili试验的数据和基础设施。数学模型 表明南非每年20万成年人感染艾滋病毒的人中，有近一半是由FSW感染的，他们的 客户或其客户的合作伙伴，从而处理这些未得到满足的需求可能会导致更好的健康结果 妇女和人口作为一个整体。具体目标1：描述女性性工作者中药物使用的特征 参与Siyaphambili试验的HIV患者，重点是确定多种物质使用的时间模式， 利用潜在转变分析(LTA)，他们的相关决定因素(例如，暴力、耻辱、经济 脆弱性)，以及如果他们修改顺序适应战略的有效性以改善艾滋病毒护理 结果。具体目标2：就如何提供物质使用进行混合方法形成性研究 在HIV护理的背景下，通过对200名FSW进行半结构化访谈，在HIV护理的背景下治疗FSW Siyaphambili研究或在结核病艾滋病毒护理(THC)治疗和预防计划中报告任何 非法药物使用，以确定与药物有关的经历、治疗(例如，类型、复发)、意愿 治疗，以及使用离散选择实验的治疗偏好。这一数据将得到以下补充 深入访谈通过我们的 与THC合作。具体目标3：组织实施发展工作组，启动串扰 与国内外合作伙伴就FSW的实质内容进行合作，完善紧急实施战略 用于跨环境进行评估。R21将允许在Siyaphambili试验中额外关注物质使用， 包括引入实现拟议目标所需的额外内容和方法专门知识。 我们还将收集主要数据，为制定和实施干预措施提供信息，以解决 FSW在艾滋病毒护理方面的物质使用，以及开展加强国际合作的活动 为实现这一目标而努力的合作。建议的R21与NIH OAR的多个优先事项保持一致，包括 减少艾滋病毒发病率(通过优化治疗)，通过利用现有的 队列，并将直接为关于药物使用治疗和艾滋病毒护理执行情况的R01研究提供信息 在这一关键人群中。

Project Summary/Abstract The goal of this project is to increase an understanding of substance use, how it impacts HIV care, and how to address it in a critical population, female sex workers (FSW) aged 18 years and older, in South Africa (SA), using data and infrastructure from an ongoing adaptive intervention, the Siyaphambili trial. Mathematical models suggest that nearly half of the 200,000 annual HIV infections among adults in SA are acquired by FSW, their clients, or partners of their clients and thus treating these unmet needs could result in better health outcomes for women and the population as a whole. Specific Aim 1: Characterize substance use among the FSW living with HIV who participated in the Siyaphambili trial, with a focus on identifying temporal patterns of polysubstance use, using Latent Transition Analysis (LTA), their associated determinants (e.g., violence, stigma, economic vulnerability), and if they modify the effectiveness of the sequentially adaptive strategy to improve HIV care outcomes. Specific Aim 2: Conduct mixed methods formative research on how to deliver substance use treatment for FSW in the context of HIV care through semi-structured interviews with 200 FSW engaged in the Siyaphambili study or in the TB HIV Care (THC) treatment and prevention sex worker program who report any illicit drug use, to ascertain experiences with substances, treatment (e.g. types, relapse), willingness for treatment, and preferences for treatment using a discrete choice experiment. This data will be supplemented by in-depth interviews with 10 implementation partners (e.g., nurses, clinic management) recruited through our partnership with THC. Specific Aim 3: Organize an Implementation Development Workgroup to initiate crosstalk with domestic and international collaborators on substance in FSW to refine emergent implementation strategies for evaluation across contexts. This R21 will allow an additional focus on substance use in the Siyaphambili trial, including bringing on the additional content and methodological expertise needed to achieve the proposed aims. We will also collect primary data to inform the development and implementation of interventions that address substance use among FSW in the context of HIV care, as well as conduct activities that strengthen international collaborations working toward this end. The proposed R21 is aligned with multiple NIH OAR priorities, including reducing HIV incidence (through optimized treatment), has a high likelihood of success by leveraging an existing cohort, and will directly inform an R01 study on the implementation of substance use treatment and HIV care among this key population.