CAMELLIA Cohort: A longitudinal study to understand sexual health and prevention among women in Alabama

摘要 尽管有有效的艾滋病毒预防工具，如暴露前预防(PrEP)，但显著 有色人种群体之间的差异依然存在，特别是在南方腹地的妇女中，那里的 黑人女性的艾滋病毒感染率是白人女性的14倍。准备使用率保持不变 在南方腹地的女性中比例很低，据估计，阿拉巴马州有7%的合格女性接受PrEP。 此外，确定PrEP资格的算法对女性的预测能力很差。这项建议 利用经验丰富的艾滋病毒预防研究人员的动态和创新合作 阿拉巴马大学伯明翰分校，北卡罗来纳大学教堂山分校，艾滋病研究中心， 阿拉巴马州公共卫生部(ADPH)和社会科学系统。这项新奇的研究 建议利用以人口为基础的方法来建立具有地理代表性的顺位-和 根据最近的研究，跨性别者女性(‘Camellia Cohort’)未来感染艾滋病毒的风险很大 淋病或梅毒感染，横跨阿拉巴马州(AL)，被强调为地理热点 联邦终止艾滋病毒流行战略，以更好地了解与性传播感染和艾滋病毒风险相关的因素 PrEP使用的诊断和预测指标。这项提议的目的是：1)完善医疗授权 (HMP)数字平台，以前用于提供循证干预措施，以改善艾滋病毒和 黑人男男性行为者和变性人女性的预防结果，包括关键 以最佳方式吸引和留住AL中艾滋病毒高危人群的要素；这将通过以下方式实现 利益相关者参与了关于PrEP的自我认同女性的研究，PrEP护理团队成员使用 名义上的群体技术；2)招募和保留800人的地理多样化和乡村增强的队列 18-44岁的女性，最近淋病或梅毒检测呈阳性，但未感染STI和HIV 登记，参加Camellia数字队列，利用地理上多样化的抽样框架 使用公共和商业可用的县级艾滋病毒和性传播感染年度检测数据和3)评估 山茶花中STI/HIV发病率和PrEP使用和依从性的预测、调节和调节因素 通过HMP数字平台收集人口统计、行为和社区级别的评估 通过ADPH的家庭检测计划定期进行艾滋病毒/性传播感染检测；我们将有目的地抽样 艾滋病毒易感性高和/或在队列中使用PrEP的妇女进行深入访谈(n=30)，以进一步 探索影响PrEP使用的因素，以指导未来的干预发展。这项研究将为 为测试进一步调整的HMP数字平台的实施情况的更大研究方案奠定基础 旨在改善艾滋病毒/性传播感染检测、PrEP使用率和南方腹地妇女的持久性， 重点关注艾滋病毒发病率较高的地区。

Abstract Despite the availability of effective HIV prevention tools such as pre-exposure prophylaxis (PrEP), significant disparities persist among communities of color, particularly among women in the Deep South where the rate of HIV infection is fourteen-times higher for Black women compared to White women. PrEP utilization remains low among women in the Deep South with estimates of <7% eligible women receiving PrEP in Alabama. Moreover, algorithms to determine PrEP eligibility demonstrate poor predictive power for women. The proposal takes advantage of a dynamic and innovative collaboration of experienced HIV-prevention investigators from the University of Alabama-Birmingham, University of North Carolina-Chapel Hill, Centers for AIDS Research, the Alabama Department of Public Health (ADPH), and Social Scientific Systems. This novel research proposal utilizes a population-based approach to establish a geographically representative cohort of cis- and trans-gender women (‘Camellia Cohort’) at significant risk for future HIV acquisition, based on recent gonorrhea or syphilis infection, across the state of Alabama (AL), highlighted as a geographic hotspot by the federal Ending the HIV Epidemic strategy, to better understand factors associated with risk of STI and HIV diagnosis and predictors for PrEP use. The aims of this proposal are to: 1) refine the HealthMpowerment (HMP) digital platform, previously utilized to deliver evidence-based interventions to improve HIV and prevention outcomes among Black men who have sex with men and transgender women, to include key elements that optimally engage and retain a cohort of women at-risk for HIV in AL; this will be achieved via stakeholder engaged research with self-identified women on PrEP and PrEP care team members using nominal group techniques; 2) recruit and retain a geographically-diverse and rurally-enhanced cohort of 800 women ages 18-44, with recent positive gonorrhea or syphilis testing who are STI- and HIV-uninfected at enrollment, to participate in the Camellia digital cohort utilizing a geographically diverse sampling framework using public and commercially available annual county-level HIV and STI testing data and 3) evaluate predictors, mediators and moderators for STI/HIV incidence and PrEP use and adherence in the Camellia Cohort by collecting demographic, behavioral, and community level assessments via the HMP digital platform and HIV/STI testing through ADPH’s home testing program at regular intervals; we will purposefully sample women with high HIV vulnerability and/or PrEP use within the cohort for in-depth interviews (n = 30) to further explore factors contributing to PrEP use to guide future intervention development. This research will lay the groundwork for a larger research program testing the implementation of a further adapted HMP digital platform designed to improve HIV/STI testing, PrEP utilization and persistence among women in the Deep South, focusing on areas with higher HIV incidence.