Epidemiology of Syphilis among IDUs in Tijuana, Mexico

该项目的目标是制定和试行一项外联干预措施， 通过同侪调解的转诊制度，旨在增加对女性工作者的艾滋病毒和梅毒检测， 在主要娱乐区以外的地区在蒂华纳，IVlexico。K99阶段的裁决审查 本地区静脉吸毒人群梅毒发病的个体、网络和地理因素。高 特别是女性注射吸毒者中的梅毒发病率，以及甲基苯丙胺使用的高流行率， 需要增加这一边缘化人口与卫生保健系统的联系。以前的工作 已经确定了主要娱乐区的注射吸毒者和性工作者高度集中;然而， 其他社区也已确定。迄今为止，这些地方的妇女很少参加， 因此，对他们的药物使用和感染艾滋病毒/性传播感染的风险知之甚少。当前 一项提案旨在利用形成性行为的方法， 研究和评估同行介导的外展干预使用邻里水平的随机 对照试验标准的外展干预措施，包括与 社区，将与纳入受访者驱动抽样的增强干预措施进行比较 （RDS）的同行推荐系统。空间和环境因素（位置、距离、建筑环境） 还将评估移动的外联干预措施的效果。一个具有地域代表性的样本， 来自每个社区的妇女将被前瞻性地跟踪，以确定他们的能力。 同行驱动的方法，以增加㈠获得干预措施的妇女比例，㈡多样性， 获得干预措施的妇女比例和患病）社区一级艾滋病毒/性传播感染的变化 知识和风险行为。这与NIDA的流行病学、服务和预防司一致 研究促进“理解和处理个人之间互动的综合办法” 造成一系列与药物使用有关的问题的环境”。

The objectives of this fJroposal are to tdevelop and pilot an outreach intervention, incorporating a peer-mediated referral system, and aimed at increasing HIV and syphilis testing among female workers in areas outside of the main entertainment district in Tijuana, IVlexico. The K99 phase of the award examined the individual, network and geographic factors associated with syphilis among IDU in this region. The high rates of syphilis among female IDU in particular, and the high prevalence of methamphetamine use highlight the need to increase connections of this marginalized population to the health care system. Previous work has identified high concentrations of IDU and FSW in the main entertainment district; however, venues In other neighborhoods have also been identified. To date, few women from these locations have participated in studies and therefore little is known about their substance use and risk for HIV/STIs. The current proposal aims to uncover barriers to accessing sexual health care in this population using formative research and to evaluate a peer-mediated outreach intervention using a neighborhood-level randomized controlled trial. A standard outreach intervention, incorporating sexual health messages developed with the community, will be compared to an enhanced intervention incorporating a Respondent-Driven Sampling (RDS)-based peer-referral system. Spatial and envirnomental factors (location, distance, built environment) of the mobile outreach intervention will also be evaluated. A geographically representative sample of women from each neighborhood will be prospectively followed in order to determine the ability of the peer-driven method to increase i) proportion of women accessing the intervention, ii) diversity and representation of women accessing the intervention and ill) neighborhood-level changes in HIV/STI knowledge and risk behaviors. This is in line with NIDA's Division of Epidemiology, Service and Prevention Research to promote "integrated approaches to understand and address interactions between individuals and environments that contribute to the continuum of problems related to drug use".