Using CBPR to Engage Hazardous Drinking Women in the HIV Prevention and Care Continuum

在美国，妇女占艾滋病毒感染者（PLWH）的四分之一，而非洲裔美国人（AA） 女性只占美国女性人口的14%，但她们占生活在美国的女性的60%以上。 艾滋病毒（WLWH）。2013年，马里兰州的艾滋病毒感染率仅次于华盛顿，位居第二 女性的诊断。滥用酒精中断了艾滋病毒预防和护理连续性的关键步骤 （HPACC），从而导致风险人群和WLWH之间的健康差异。我们之前的工作 巴尔的摩已经证明了酒精滥用和艾滋病毒风险行为之间的密切联系， 艾滋病毒/艾滋病感染风险和WLWH，艾滋病毒护理的保留率较低，抗逆转录病毒疗法的使用和坚持率较低。 我们已经开发了基于理论的，在人和计算机交付的简短干预（CBI）的风险和 WLWH与酒精滥用，在最近的RCT中证明了饮酒减少。然而，行为和 酒精干预措施的最佳吸收和参与HPACC的结构性障碍仍然存在，包括 心理健康并发症和低知识，获得和使用艾滋病毒预防措施，如艾滋病毒预防， 暴露预防（PrEP）。让关键利益相关者参与，包括风险和WLWH以及社区 组织和领导人，对于成功实施艾滋病毒交叉点的干预措施至关重要 女性酗酒的问题该提案的目标有两个方面：1）建立在我们目前的基础上， 社区伙伴关系，以确定如何最佳实施循证酒精治疗的风险 和WLWH在巴尔的摩，和2），以确定是否添加信息，动机和同行 与共病心理健康相关的导航支持和艾滋病毒预防实践可以增强CBI， 改善高危人群和WLWH中的酒精和HPACC结果。为了实现这些目标，我们将使用 基于社区的前瞻性研究（CBPR）方法，让患者和社区利益相关者参与 在研究开发和社区试点测试的各个方面。与我们的社区合作 咨询委员会（CAB），我们将：1）通过短信调整我们当前的CBI，以解决艾滋病毒方面的差距 预防和护理连续体。我们将与高危人群和WLWH进行焦点小组讨论， 干预手册，然后是试点和进一步的反馈和修改。2)我们将进行试点 在60例高危或WLWH患者中进行CBI-CC +文本和同行导航的随机对照试验（RCT）， 滥用酒精在3个月和6个月时评估的主要结果包括饮酒天数、重度饮酒天数、 其他结果包括不使用安全套的性行为天数、心理健康和物质 使用治疗参与，并采用艾滋病毒预防做法（艾滋病毒检测，PrEP，避孕套）。 这项U34规划赠款，我们将与社区的主要利益相关者合作， 针对酒精与艾滋病毒之间的关系，为高危人群和酒精导致的WLWH采取有效的循证干预措施 滥用，并改善对艾滋病毒预防和护理连续体的参与。

Women account for 1 in 4 people living with HIV (PLWH) in the United States, and while African American (AA) women comprise only 14% of the US female population, they account for greater than 60% of women living with HIV (WLWH). In 2013, the state of Maryland was second only to Washington, DC in the rates of HIV diagnoses among women. Alcohol misuse interrupts critical steps in the HIV prevention and care continuum (HPACC) and thus contributes to significant health disparities among at-risk and WLWH. Our prior work in Baltimore has demonstrated a strong association between alcohol misuse and HIV risk behaviors among at risk and WLWH, poorer retention in HIV care and lower use of and adherence to antiretroviral therapy (ART). We have developed theory-based, in-person and computer-delivered brief interventions (CBI) for at risk and WLWH with alcohol misuse, demonstrating drinking reductions in recent RCTs. However behavioral and structural barriers to optimal uptake of alcohol interventions and engagement in the HPACC remain, including mental health comorbidity and low knowledge, access, and use of HIV prevention practices such as HIV pre- exposure prophylaxis (PrEP). Engaging key stakeholders, including at-risk and WLWH, and community organizations and leaders, is critical to successful implementation of interventions at the intersection of HIV and alcohol misuse among women. The goals of this proposal are two-fold: 1) to build on our current community partnerships to determine how to optimally implement evidence based alcohol treatment for at risk and WLWH in Baltimore, and 2) to determine whether the addition of information, motivational and peer navigator support related to comorbid mental health, and HIV prevention practices can enhance CBI and improve alcohol and HPACC outcomes among at risk and WLWH. To achieve these goals we will use a Community Based Participatory Research (CBPR) approach, engaging patient and community stakeholders during all aspects of study development, and community pilot testing. In collaboration with our Community Advisory Board (CAB), we will: 1) adapt our current CBI with text messaging to address gaps in the HIV prevention and care continuum (CBI-CC). We will conduct focus groups with both at risk and WLWH to tailor intervention manuals, followed by piloting and further feedback and modification. 2) We will conduct a pilot randomized controlled trial (RCT) of CBI-CC + text and peer navigation among 60 at-risk or WLWH with alcohol misuse. Primary outcomes, assessed at 3 and 6 months, include drinking days, heavy drinking days, drinks per drinking day; other outcomes include days of sex without condom use, mental health and substance use treatment engagement, and uptake of HIV prevention practices (HIV testing, PrEP, condoms).Through this U34 planning grant we will partner with key stakeholders in the community to build capacity to deliver effective, evidence-based interventions at the nexus of alcohol and HIV for at risk and WLWH with alcohol misuse, and improve engagement in the HIV prevention and care continuum.