Adaptation and Implementation of Project Encuentro in the U.S.-Mexico Border

 描述(由申请人提供)：拟议的项目是德克萨斯大学埃尔帕索分校、边境合作联盟和计划比较机构之间的研究合作，以适应、实施和评估多层次的、基于社区的艾滋病毒预防干预措施(Encuentro项目)。这项干预措施将针对活跃的海洛因和吸毒者，包括通过社交网络艾滋病毒检测组件增加获得艾滋病毒检测的机会，并通过同伴网络简短的行为干预降低性和药物使用风险。Encuentro还包括举办社区提高认识会议，以针对影响艾滋病毒风险的结构性因素。这项干预措施是在萨尔瓦多这个受到暴力和对吸毒者耻辱严重影响的地区开发的，这使得它特别适合适应生活在拟议干预地点美国-墨西哥边境的吸毒者的需求。拟议的干预地点也受到暴力的严重影响，这阻碍了先前任何降低吸毒者艾滋病毒风险的尝试。暴力加剧了影响艾滋病毒风险的结构性因素，例如增加了警察的迫害和污名，减少了获得资源的机会。在我们拟议的项目中，我们将进行形成性研究，以了解暴力后边境地区吸毒者艾滋病毒风险的背景，并相应地调整干预措施。调查结果将使我们能够量身定做干预措施，以满足该地区吸毒者的需求。随后，我们建议测试干预的有效性，并评估实施障碍和促进者。为了实现我们的项目目标，我们将使用定性和定量相结合的方法。我们将从形成阶段开始，对居住在该区域的40名吸毒者进行深入访谈，以了解暴力事件如何改变吸毒风险的背景，并将进行一项社会网络调查(n=200)，以确定风险网络的结构。调查结果将产生必要的信息，以便在文化上调整干预措施，以满足该区域吸毒者的需要，并将帮助我们将招聘工作集中在风险最高的网络所在的地方。在我们的社区咨询委员会和社区联盟的帮助下调整干预措施后，我们将实施干预措施，并将通过对吸毒者(n=1,200)进行6次横断面调查来评估干预的有效性和覆盖面。我们将通过对所有干预活动进行人种学实地记录，包括社区参与以及社区协调委员会和联盟会议，来评估执行进程。我们将评估干预的保真度和质量。最后，我们将与参与该项目的主要利益攸关方进行关键的线人访谈，采访和观察的编码将反映与在两个干预地点(德克萨斯州埃尔帕索和墨西哥华雷斯)成功实施干预部分有关的关键系统因素。这些发现将具有非常重要的意义，因为我们将对在两个非常不同的背景下对拉丁裔吸毒者有效的干预措施的有效性进行平行研究：萨尔瓦多和美国-墨西哥边境。调查结果将阐明执行方面的挑战和障碍，这些信息随后可用于评估努力满足拉丁裔吸毒者需求的组织中各种执行战略的有效性。

 DESCRIPTION (provided by applicant): The proposed project is a research collaboration between the University of Texas at El Paso, The Alliance for Border Collaborative and Program Comparers to adapt, implement, and evaluate a multi-level, community-based, HIV prevention intervention (Project Encuentro). The intervention will target active heroin and crack users and consists of increasing access to HIV testing via a social network HIV testing component and reducing sexual and drug use risk via a peer network brief behavioral Intervention. Encuentro also consists of conducting community awareness meeting to target structural factors affecting HIV risk. The intervention was developed in an area severely affected by violence and stigma towards drug users, El Salvador, which makes it particularly suitable for adaptation to meet the needs of drug users living in the proposed intervention site, the U.S.-Mexico border. The proposed intervention site also has been severely affected by violence which has curtailed any prior attempts to reduce the risk drug users' HIV risk. Violence has worsened structural factors which affect HIV risk such as, increasing police persecution and stigma and reducing access to resources. In our proposed project, we will engage in formative research to understand the context of HIV risk of drug users in the border region post violence and adapt the intervention accordingly. Findings will allow us to tailor intervention components to meet the needs of drug users in the region. Subsequently, we propose to test intervention effectiveness and evaluate implementation barriers and facilitators. To accomplish our project aims we will use a mixed qualitative, quantitative approach. We will begin with a formative phase by conducting in-depth interviews with drug users (n = 40) living in the region to understand how the context of drug use risk changed as a result of the violence and will administer a social network survey (n = 200) to characterize the configuration of risk networks. Findings will yield the necessary information to culturally adapt the intervention to meet the needs of drug users in the region and will help us focus our recruitment efforts where the riskiest networks are located. After the intervention is adapted with the help of our community advisory board and our community coalition, we will implement the intervention and will assess the effectiveness and reach via 6 cross-sectional surveys administered to drug users (n=1,200). We will assess the process of implementation by conducting ethnographic field notes of all intervention activities including community engagement and CAB and coalition meetings. We will assess the fidelity and quality of the intervention. Lastly, we will conduct key informant interviews with key stakeholders involved in the project and interviews and observations will be coded to reflect key systems factors related to successful implementation of intervention components in two intervention sites (El Paso, Texas and Ciudad Juarez, Mexico). Findings will be highly significant as we will be conducting parallel research on the effectiveness of interventions shown to be effective in Latino drug users in two very different contexts: El Salvador and the U.S-Mexico border. Findings will elucidate implementation challenges and barriers and such information can then be used to assess the effectiveness of diverse implementation strategies in organizations working to serve the needs of Latino drug users.