Community Engagement to Enhance EBI Implementation in a Public Housing Community

 描述（由申请人提供）：为了使艾滋病毒预防工作最有效，他们必须接触风险最大的人群，使用有效的干预措施，并在现实世界中可交付。虽然目前存在许多有效的艾滋病毒预防循证干预措施，但社区组织往往难以在最有可能受益的人群中实施这些措施，并确保其忠实性、良好效果和可持续性。结构 与贫困有关的因素往往阻碍在最需要方案的社区提供艾滋病毒预防服务。社区组织要想成功地预防艾滋病毒在高危社区的传播，就需要制定战略，克服执行方面的挑战。基于社区的参与式研究（CBPR）提供了一种与社区成员合作的方法，以确定社区资源，优先事项，需求和实施中要考虑的障碍。这个应用程序探讨了这些问题之间的一个往往被低估的群体在艾滋病毒的风险大大增加：非洲裔美国妇女在美国南部。南方受艾滋病毒流行病的影响尤其严重，在过去十年中发病率不断上升，非洲裔美国人和妇女的负担最大。在过去的25年里，妇女的艾滋病毒负担也从美国艾滋病病例的8%增加到25%以上。虽然非洲裔美国妇女仅占美国妇女的12%，但她们占新感染妇女的64%。在以前的研究中，北卡罗来纳州的非洲裔美国妇女报告说，在社区获得艾滋病毒预防方案方面存在重大的结构性障碍，如缺乏交通和儿童保育，粮食不安全，和竞争的需求，并建议在公共住房设施内或附近提供计划可能是克服这些障碍的一种可行方法，许多艾滋病毒高危人群集中在一起。在一个独特的，跨学科的合作，CAARE，和达勒姆住房管理局，这个应用程序的中心目标是设计一个结构知情的实施方案计划，可持续的艾滋病毒预防在公共住房的发展，使用真实的艾滋病预防计划EBI的非洲裔美国妇女，作为一个测试案例模型，在三个目标。我们将1）通过CBPR方法，让广泛的社区利益相关者参与研究方法的设计，并为居住在美国南部公共住房开发区的妇女调整RAPP; 2）在DHA居民和DHA和CAARE工作人员中了解社区资源，需求，优先事项和实施艾滋病毒预防计划的障碍，特别是RAPP; 3）创建一个可复制的项目计划，在南部住房管理局的开发项目中实施RAPP，并在DHA中对实施计划进行试点测试，以确保其真实性、可行性和可接受性。如果成功，我们的下一步将是在R 01应用程序中在美国南部多个地点更广泛地测试实施计划。

 DESCRIPTION (provided by applicant): For HIV prevention efforts to be most effective they must reach populations most at risk, use efficacious interventions, and be deliverable in real-world settings. While many efficacious evidence-based interventions (EBIs) for HIV prevention currently exist, community-based organizations (CBOs) often have difficulties implementing them among those most likely to benefit, with fidelity, good effect, and sustainability. Structural factors related to poverty often hinder HIV prevention delivery in communities most in need of the programs. For CBOs to successfully prevent the transmission of HIV in high risk communities, strategies to overcome the challenges of implementation are needed. Community-based participatory research (CBPR) offers one approach to work with community members to pinpoint community resources, priorities, needs, and barriers to consider in implementation. This application explores these issues among an often under-recognized group at enormously increased risk of HIV: African American women in the US South. The South is disproportionately affected by the HIV epidemic, with incidence rising over the last decade, and the largest burden on African Americans and women. HIV burden in women has also grown the past 25 years from 8% to over 25% of US AIDS cases. While African American women are only 12% of US women, they comprise 64% of newly infected women. Compounding the great need represented by these disparities, in previous studies, African American women in North Carolina reported significant structural obstacles to accessing HIV prevention programs in their communities, such as lack of transportation and childcare, food insecurity, and competing demands and suggested that program delivery in or near public housing facilities may represent a feasible way to overcome some of these barriers in locations where many people at elevated risk of HIV are concentrated. In a unique, transdisciplinary collaboration between UNC, CAARE, and the Durham Housing Authority, the central objective of this application is to design a structurally-informed implementation program plan for sustainable HIV prevention in public housing developments, using the Real AIDS Prevention Program EBI for African American women, as a test-case model in three aims. We will 1) Engage a broad range of community stakeholders to participate in the design of study methods and adaptation of RAPP for women living in public housing developments in the southern US through CBPR methods; 2) Understand perceived community resources, needs, priorities, and obstacles to the implementation of HIV prevention programs, particularly RAPP, among DHA residents and DHA and CAARE staff; 3) Create a replicable program plan for implementing RAPP within southern housing authority developments and pilot-test the implementation plan within the DHA for fidelity, feasibility, and acceptability.If successful, our next step will be to test the implementation program plan more widely at multiple southern US sites in an R01 application.