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

 描述(由申请人提供)：为响应RFA-DA-15-019在寻找、测试、治疗和保留(STTR)框架内开发和测试以年龄为重点的艾滋病毒模型的交付，该应用程序建议接触到北卡罗来纳州18至25岁的年轻吸毒者、性高危、艾滋病毒幼稚的非裔美国妇女。这些年轻妇女中艾滋病毒和性传播感染的高发病率是由吸毒、避孕套使用不当以及诸如耻辱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有效地将年轻妇女与药物滥用治疗联系起来的能力。这些年轻妇女中的许多人继续滥用药物，反复发生性传播感染，由于缺乏防护技能和其他共病和背景条件，艾滋病毒感染的风险仍然很高。我们提出了一种混合方法来开发和测试有效性，并检查了在艾滋病毒检测诊所启动的适合年龄的、以女性为重点的艾滋病毒干预的两种交付策略，该干预将提供风险降低、赋权技能以及与药物滥用治疗的联系。与NIDA寻求和测试STTR框架的方面一致，我们将在三个县的低资源社区寻找18至25岁的年轻的性活跃和吸毒的非裔美国妇女，她们最近或从未进行过艾滋病毒检测。为了检查干预措施的效果，我们将收集关于行为(即药物和性风险、共病、生殖健康、赋权、治疗)和生物(即艾滋病毒、性传播感染[淋病、衣原体]、药物使用和怀孕)结果的衡量标准。我们将使用三臂群组随机设计在三个县的艾滋病毒诊所内测试以妇女为中心的干预措施，面对面和mHealth两种形式，其中各县被随机分为(1)艾滋病毒咨询和检测(HCT)作为对照，(2)将接受干预培训的HCT工作人员面对面进行干预(包括提高工作人员对年龄的敏感性的活动--与性别有关的问题、耻辱和其他结构性障碍，减少这些年轻女性获得艾滋病毒/性传播服务和药物滥用治疗的机会)；以及(3)将使用交互式应用程序在智能手机上提供的mHealth格式，这是一项创新，一旦参与者完成艾滋病毒检测，就可以轻松地整合到他们的生活中。我们计划评估成本，并检查工作人员和参与者新的面对面(在诊所)和mHealth(在智能手机上)干预措施的可接受性和可持续性方面的结构性结果。这两种形式相对于母婴传播疗法的总体影响，将为年轻的、使用药物的非裔美国妇女提供以性别为重点的替代战略，作为“艾滋病毒预防模式”，并确定新的干预措施是否是确保干预可持续性和产生积极行为和生物学结果的更可行的战略。

 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.