Young Women-Focused HIV Prevention: Seek & Test in NC Clinics

 描述（由申请方提供）：为了响应RFA-DA-15-019，在寻求、检测、治疗和保留（STTR）框架内开发和测试适合年龄的HIV重点模型，本申请建议覆盖北卡罗来纳州年龄在18至25岁之间的年轻吸毒、性风险、HIV初治、非裔美国女性。这些年轻妇女中艾滋病毒和性传播感染的高发率是由吸毒、避孕套使用不当以及诸如污名化和缺乏适合年龄的艾滋病毒/性传播感染预防和治疗服务等结构性因素造成的。大多数艾滋病毒/性传播感染诊所没有提供药物滥用咨询或将年轻妇女与药物滥用治疗有效联系起来的设备。其中许多年轻妇女继续滥用药物，性传播感染反复发作，由于缺乏保护技能和其他共病和环境条件，感染艾滋病毒的风险仍然很高。我们提出了一种混合方法的方法来开发和测试的功效，并检查两个交付策略的年龄相适应的，以妇女为中心的艾滋病毒检测诊所，将提供风险降低，赋权技能，并链接到药物滥用治疗开始的艾滋病毒干预。与NIDA的STTR框架的寻求和测试方面相一致，我们将在三个县的低资源社区寻求18至25岁的年轻性活跃和吸毒的非洲裔美国妇女，她们最近或曾经没有进行过艾滋病毒测试。为了检查干预措施的有效性，我们将收集行为指标（即，药物和性风险、并发症、生殖健康、赋权、治疗）和生物（即，HIV、STI [淋病、衣原体]、药物使用和妊娠）结果。我们将在三个县的艾滋病毒诊所内采用三臂随机分组设计，以面对面和移动健康两种形式测试以女性为重点的干预措施，其中县被随机分配到（1）艾滋病毒咨询和检测（HCT）作为对照，（2）由接受过干预培训的HCT工作人员进行面对面的形式（包括开展活动，使工作人员敏感地认识到与年龄和性别有关的问题、耻辱和其他结构性障碍，这些障碍减少了这些年轻妇女获得艾滋病毒/性传播感染服务和药物滥用治疗的机会）;以及（3）移动健康模式，将使用交互式应用程序在智能手机上提供，这是一项创新，一旦参与者完成艾滋病毒检测，就可以轻松融入他们的生活。我们计划估计成本，并检查结构性成果的可接受性和可持续性的新的面对面（在诊所）和移动健康（智能手机）的工作人员和参与者的干预措施。这两种形式的总体影响，相对于HCT，将提供替代性的性别为重点的战略作为“艾滋病毒预防模式”在一个新的结构，年轻的，物质使用的非洲裔美国妇女，并确定新的干预措施是否是一个更可行的战略，以确保干预的可持续性和产生积极的行为和生物学结果。

 DESCRIPTION (provided by applicant): In response to RFA-DA-15-019 to develop and test the delivery of age-appropriate HIV-focused models within the seek, test, treat, and retain (STTR) framework, this application proposes to reach young substance-using, sexually at-risk, HIV naïve, African American women aged 18 to 25 years old in North Carolina. High incidence of HIV and sexually transmitted infections (STIs) among these young women is driven by drug use, poor condom use, and structural factors such as stigma and lack of age-appropriate services for HIV/STI prevention and treatment. Most HIV/STI clinics are not equipped to provide substance abuse counseling or to effectively link young women to substance abuse treatment. Many of these young women continue to abuse substances, have recurring STIs, and remain at high risk for HIV due to a lack of protective skills and other comorbid and contextual conditions. We propose a mixed-methods approach to develop and test the efficacy and examine two delivery strategies of an age-appropriate, woman-focused HIV intervention initiated in HIV testing clinics that will provide risk reduction, empowerment skills, and linkage to substance abuse treatment. Consistent with NIDA's seek and test aspects of the STTR framework, we will seek young sexually active and drug-using African American women aged 18 to 25 in low-resource communities in three counties who have not tested recently or ever for HIV. To examine the efficacy of the interventions, we will collect measures on behavioral (i.e., drug and sexual risk, comorbidity, reproductive health, empowerment, treatment) and biological (i.e., HIV, STIs [gonorrhea, chlamydia], drug use, and pregnancy) outcomes. We will test the woman-focused intervention conducted in two formats, face- to-face and mHealth, within HIV clinics in three counties using a three-arm cluster-randomized design in which counties are randomized to (1) HIV counseling and testing (HCT) as the control, (2) the face-to-face format by HCT staff who will be trained to deliver the intervention (including activities to sensitize staff to age- an gender-related issues, stigma, and other structural barriers that reduce these young women's access to HIV/STI services and substance abuse treatment); and (3) the mHealth format that will be delivered on smartphones using an interactive app, an innovation that can be easily integrated into participants lives once they complete HIV testing. We plan to estimate the costs and examine structural outcomes regarding the acceptability and sustainability of the new face-to-face (in the clinic) and mHealth (on smartphones) interventions from both staff and participants. The overall impact of both of these formats, relative to HCT, will offer alternative gender-focused strategies as "HIV prevention models" in a new structure for young, substance-using African American women, and determine whether the new intervention is a more viable strategy for ensuring intervention sustainability and producing positive behavior and biological results.