Optimizing PrEP Utilization among Alcohol and Other Drug (AOD) Using Women of Color

项目摘要 当我们接近艾滋病流行的半个世纪标志时，有色人种妇女所受的不成比例的影响 在美国继续震荡。由于性别原因，妇女总体上在这一流行病中处于不利地位 这些差异和规范形成了生物、社会和经济脆弱性。种族和民族差异 放大风险。酒精和其他药物的使用等辅助因素相互交叉，并加强了其他因素， 合并症。生活在高患病率地区会显著增加风险， 克服帮助妇女保持艾滋病毒阴性的选择有限。然而，这一障碍改变了几个 几年前，FDA批准和CDC认可口服暴露前预防（PrEP）。然而，大多数人 的美国女性不知道PrEP可以是女性控制的策略，也不知道它适用于她们， 供应商或其社区尚未提供支持。然而，最令人不安的是 缺乏PrEP作为该国高影响地区有色人种妇女的可获得战略。这 发展U34响应RFA-AA-17-013，优先考虑基于社区的参与性研究 （CBPR）为高影响地区的妇女制定解决酒精和艾滋病毒问题的实施模式， 社区.拟议的研究将产生证据和CBPR驱动的PrEP实施 干预措施，以提高吸收和优化使用妇女的颜色在南佛罗里达，这是目前的 美国艾滋病毒感染率最高的地区，最近被CDC确定为美国艾滋病毒感染率最高的地区。 民族该研究建立在该团队在南佛罗里达的酒精/艾滋病干预和CBPR的经验基础上 与大迈阿密和劳德代尔堡地区的利益攸关方开展初步工作， 针对从事危险性行为的非洲裔美国人、拉丁裔和海地妇女的一级PrEP干预计划， AOD使用。这项研究包括来自南方艾滋病毒和酒精研究联盟（SHARC）的研究人员 并将告知目标组和对照组的设计以及U 01的其他特征，以便在 NIAAA CHAART财团在社会生态框架的指导下，研究将：确定需求， 优先事项和社区优势，并在峰会期间制定PrEP连续体，以吸引利益相关者 (Aim 1）制定可复制的实施方案，包括手册、材料、工具， 通过成立社区咨询和宣传委员会（目标2）， 在布劳沃德县和迈阿密戴德县的120名多种族有色人种妇女中进行了探索性试点，以测试忠诚度， 可行性和可接受性，并在6个月内测量PrEP吸收、依从性和保留率 期本研究将利用子样本中的生物标志物与自我报告和药房再填充进行比较 措施它将是第一批在南方为有色人种妇女制定PrEP干预措施的国家之一，因此， 根据艾滋病研究办公室在交叉研究方面的具体高资助优先事项， 在制定PrEP等生物行为策略的实施方法时减少健康差异。

Project Summary As we edge closer to the half century mark of the HIV epidemic, the disproportionate effect on women of color in the U.S. continues to be jolting. Women overall have been at a disadvantage in the epidemic due to gender differences and norms that shape biological, social and economic vulnerability. Racial and ethnic disparities magnify the risk. Co-factors such as alcohol and other drug (AOD) use intersect and reinforce other comorbidities. Living in a high prevalence area significantly hardens the risk and makes it tougher to overcome. Options to help women stay HIV negative have been limited. However, this obstacle shifted several years ago with FDA approval and CDC endorsement of oral pre-exposure prophylaxis (PrEP). Yet, the majority of U.S. women do not know that PrEP can be a female-controlled strategy or that it applies to them—and backup has not been forthcoming from providers or their communities. What is most disturbing, however, is the absence of PrEP as an accessible strategy among women of color in high impact regions of the country. This developmental U34 responds to RFA-AA-17-013, which prioritizes community based participatory research (CBPR) to develop implementation models for women that address alcohol and HIV in high impact regions and communities. The proposed study will produce an evidence- and CBPR-driven PrEP implementation intervention to enhance uptake and optimize use among women of color in South Florida, which is currently the highest impact region of the U.S. with HIV rates recently determined by the CDC to be the highest in the nation. The study builds upon the team’s experience in alcohol/HIV intervention and CBPR in South Florida and preliminary work with stakeholders from the greater Miami and Fort Lauderdale areas to develop a multi- level PrEP intervention program for African American, Latina, and Haitian women who engage in risky sex and AOD use. The study includes researchers from the Southern HIV and Alcohol Research Consortium (SHARC) and will inform the design of target and comparison groups and other features of a U01 for further study within the NIAAA CHAART Consortia. Guided by the social ecological framework, the study will: identify needs, priorities, and community strengths and develop a PrEP continuum during a summit to engage stakeholders (Aim 1); produce a replicable implementation program, including manuals, materials, instruments, and procedures, through the formation of a Community Advisory and Advocacy Board (Aim 2); and conduct an exploratory pilot among 120 multi-ethnic women of color in Broward and Miami-Dade counties to test fidelity, feasibility and acceptability and measure PrEP uptake and adherence and retention in care over a 6 month period. The study will utilize biomarkers in a subsample to compare with self-reports and pharmacy refill measures. It will be among the first to develop a PrEP intervention in the South for women of color, and is thus in line with the specific high funding priorities of the Office of AIDS Research on cross-cutting research to reduce health disparities in developing implementation approaches for bio-behavioral strategies such as PrEP.