Seek, Test, Treat & Retain Pilot for Out of School Teens at Risk

在南非，据估计，艾滋病毒感染者比世界上任何其他地方都多，许多妇女为了生存而进行性交易，因此必须采取有针对性的循证战略，以接触弱势妇女群体。为了实现RFA-DA 11 -001的目标，我们建议：（1）扩大艾滋病毒检测范围，使更多高危妇女能够接受检测，以便对艾滋病毒阳性妇女进行评估，安排并保留抗逆转录病毒治疗，（2）评估针对艾滋病毒阳性和阴性的酗酒和使用其他药物的妇女的可持续的以妇女为重点的预防做法，和（3）测量联合预防策略对ART启动、坚持、保留和降低风险行为的有效性。我们建议的合作伙伴，专业发展基金会（FPD），是南非最大的PEPFAR资助的业务计划之一。FPD负责一项医疗管理计划，为全国90，000名接受ART治疗的患者提供支持。然而，FPD目前并没有针对和接触到脆弱的使用AOD的妇女，与我们以前在同一地区接触到脆弱的使用AOD的妇女的研究相比，仅检测到8.5%的艾滋病毒阳性，估计性工作者的艾滋病毒感染率为65%，非性工作者为26%。基于这一迫切需要，以达到一些最脆弱的南非妇女，我们建议联合收割机我们的能力，与科学和医学专业知识的合作，从艾滋病研究中心，提供一个组合的预防方法，优化测试，治疗和保留（TTR）的战略，以达到高风险，脆弱，使用AOD的妇女。我们将使用一种地理聚类随机设计来比较妇女健康合作社（WHC）外展和干预计划-一种经过验证的以妇女为重点的加强艾滋病毒预防战略，解决艾滋病毒阳性和阴性妇女的AOD使用，性风险行为，基于性别的暴力，赋权，技能培训和个性化行动计划-加上自愿咨询和检测（VCT），单独进行VCT作为标准做法。针对使用AOD、有多个性伙伴和避孕套使用率低的高危妇女，也会影响到她们的其他性伙伴，从而影响到更广泛的社区。拟议研究的总体目标是确定这种针对特定风险群体的预防和强化综合战略是否比目前的标准做法更有效。拟议的综合预防干预措施是专门设计的，以达到更多的风险脆弱的使用AOD的妇女，并在现有的实施方案进行测试。如果这种以妇女为重点的综合预防干预措施证明是有效的，就很有可能得到广泛实施，并通过降低南非极高的艾滋病毒发病率，对公共卫生产生重大影响。

DESCRIPTION (provided by applicant) In South Africa, where it is estimated that more people have HIV than anywhere else in the world and where many women trade sex in order to survive, targeted evidence-based strategies to reach vulnerable populations of women are essential. To address the objectives of RFA-DA11-001, we propose to (1) expand HIV testing to reach more at-risk women so that HIV-positive women can be evaluated to be placed and retained on antiretroviral therapy (ART), (2) assess sustainable woman-focused prevention practices for both HIV-positive and HIV-negative alcohol and other drug (AOD)-using women, and (3) measure the effectiveness of a combined prevention strategy on ART initiation, adherence, retention, and reduced risk behavior. Our proposed partner, the Foundation for Professional Development (FPD), is one of the largest PEPFAR-funded operational programs in South Africa. FPD is responsible for a medical management program supporting 90,000 patients on ART across the country. However, FPD does not currently target and reach vulnerable AOD-using women, detecting only 8.5% HIV positive compared with our previous study in the same region reaching vulnerable AOD-using women, with an estimated HIV prevalence of 65% among sex workers and 26% among non-sex workers. Based on this critical need to reach some of the most vulnerable South African women, we propose to combine our capabilities, in collaboration with scientific and medical expertise from the UNC Center for AIDS Research, to provide a combination prevention approach that optimizes the test, treat, and retain (TTR) strategy to reach high-risk, vulnerable, AOD-using women. We will use a geographically clustered randomized design to compare the Women's Health CoOp (WHC) outreach and intervention program - a proven woman-focused enhanced HIV prevention strategy that addresses AOD use, and sex risk behaviors, gender-based violence, empowerment, skills training, and personalized action plans for both HIV-positive and HIV-negative women - plus voluntary counseling and testing (VCT), with VCT alone as standard practice. Targeting most-at-risk women who use AODs, who have multiple partners, and who have poor condom practices, will also impact their other partners and thus the wider community. The overarching goal of the proposed research is to determine whether this combined prevention and enhanced strategy targeting a specific at-risk group is more effective than current standard practices. The proposed combination prevention intervention is designed specifically to reach more at-risk vulnerable AOD-using women and be tested in an existing implementation program. If this combination woman-focused prevention intervention proves efficacious, there is a high likelihood that it can be widely implemented and have a substantial public health impact by reducing the exceedingly high HIV incidence in South Africa.