Implementation Research for Vulnerable Women in South Africa

描述(由申请人提供)：最近对南非妇女中艾滋病毒流行率的估计超过40%。在南非，艾滋病毒携带者或艾滋病毒风险携带者的脆弱妇女由于基于性别的暴力(GBV)以及酒精和其他毒品(AOD)的使用，在保护自己方面面临障碍。AOD的使用降低了接受检测的人接受艾滋病毒检测和获得抗逆转录病毒治疗(ART)的可能性，并减少了接受ART治疗的人的依从性。使用AOD还会增加可能传播艾滋病毒的行为。尽管AOD在感染艾滋病毒的妇女中普遍存在负面影响，但很少有提供艾滋病毒咨询和检测(HCT)或产前护理、药物滥用康复诊所或艾滋病毒临床护理的卫生诊所使用循证干预(EBI)来解决这一问题。自2001年以来，我们已经调整并实施了针对女性的全面EBI，即妇女健康合作(WHC)，旨在解决酒精AOD使用、性风险和GBV问题。它包含了一个个性化的行动计划，并与ART、药物滥用治疗或其他环境需求(如住房)等健康服务相联系。世界遗产中心被列入美国国际开发署《非洲性别研究简编》。我们将这一干预措施打包用于培训培训员，并准备将其纳入日常护理，以帮助解决弱势妇女面临的许多问题。因此，我们的建议是下一个合乎逻辑的步骤，以确保其在更大规模扩大之前取得成功。这一拟议的R01项目旨在开发和测试整合EBI的实施战略。我们将使用形成性方法与社区妇女、我们的社区咨询委员会、诊所工作人员和管理人员合作，制定和实施营销计划，以应对将WHC整合到提供产前或HCT服务的常规护理健康中心和药物滥用康复中心(康复中心)的挑战。形成性工作的结果将指导一系列迭代试点研究的实施，使用阶梯式楔形设计来评估实施和患者结果。具体目标：我们的具体目标包括：目标1.制定、实施和评估营销计划的适当性，以促进进入健康中心和康复场所实施世界海底隧道。目标2.通过跨健康和康复诊所的阶梯式楔形设计提供世界海底隧道，以评估实施情况(可接受性、采用率、成本、保真度、渗透率和可持续性)和服务结果(全面服务和及时的服务联系)。目的3.在6个月的随访中评估WHC患者的结果(有效性、满意度)。如果能够成功地实施EBI，并在现实环境中证明是有效和可持续的，那么在日常护理环境中实施EBI，以接触到更脆弱的使用AOD的艾滋病毒阳性妇女，可能会对公共卫生产生很大的影响。

DESCRIPTION (provided by applicant): Recent estimates of HIV prevalence among women in South Africa exceed 40%. Vulnerable women living with HIV or at risk of HIV in South Africa face barriers to protecting themselves because of gender-based violence (GBV) and alcohol and other drug (AOD) use. AOD use reduces the likelihood of testing for HIV and access to antiretroviral therapy (ART) among those who are tested and reduces adherence among those who are on ART. AOD use also increases behaviors that may transmit HIV. Despite the pervasive negative impact of AOD use among women living with HIV, very few health clinics that provide HIV counseling and testing (HCT) or antenatal care, substance abuse rehabilitation clinics, or HIV clinical care use evidence- based interventions (EBIs) to address this problem. Since 2001, we have adapted and conducted a comprehensive EBI for women, the Women's Health CoOp (WHC), that addresses alcohol AOD use, sexual risk, and GBV. It incorporates a personalized action plan complete with linkages for health services like ART, substance abuse treatment, or other environmental needs such as housing. The WHC was listed in the USAID Compendium of Gender Studies in Africa. We packaged this intervention for training of trainers and it is poised to be integrated into usual care to help address many of the issues facing vulnerable women. Consequently, our proposal is the next logical step to ensure its success before a larger scale-up can occur. This proposed R01 project seeks to develop and test an implementation strategy for integrating an EBI. We will use formative methods to collaborate with community women, our Community Advisory Boards, clinic staff, and administrators to develop and implement a marketing plan that addresses the challenges of integrating the WHC into usual care health centers where antenatal or HCT services are provided and into substance abuse rehabilitation centers (rehab). The findings from the formative work will guide the implementation in a series of iterative pilot studies using a stepped-wedge design to evaluate the implementation and patient outcomes. Specific Aims: Our specific aims include the following: Aim 1. Develop, implement, and assess the appropriateness of a marketing plan to facilitate entry into health centers and rehab sites for the implementation of the WHC. Aim 2. Deliver the WHC via a stepped-wedge design across health and rehab clinics to evaluate implementation (acceptability, adoption, cost, fidelity, penetration, and sustainability) and service outcomes (comprehensive services and timely service linkages). Aim 3. Assess WHC patient outcomes (effectiveness, satisfaction) at 6-month follow-up. Implementing an EBI in usual care settings to reach more vulnerable AOD-using women who are HIV+ has potentially high public health impact if it can be implemented successfully and shown to be effective and sustainable in real-world settings.