Resubmission: Multilevel Strategies & Tailored HIV Prevention & Care for Young Couples who use Alcohol & Other Drugs Across Cape Town

项目摘要/摘要 拟议补编旨在消除障碍，并测试新的促进者，以征聘和吸收 为生物行为夫妇Health Coop Plus(CHC+)干预做准备和ART，以及为耻辱- 社区内部结构层面的减少干预。需要注意的是，CHC+父代 研究污名干预最初被授予在社区诊所进行，并已转移到 由于新冠状病毒大流行，许多社区受到了影响。由于这些变化，CHC+Parent研究被推迟，因为 项目面临多个日常障碍，招聘减缓了研究进展，包括记录在案的 社区暴力、抗议、帮派暴力和社区动乱。CHC+团队也在调整以适应 连续轮流停电，不仅包括电力供应，还包括增加旅行时间 红绿灯熄灭，移动网络导致与参与者沟通减少 覆盖范围中断。此外，药物使用率持续居高不下--包括酗酒， 甲基苯丙胺、安非他酮和大麻的使用--正如我们的初步行为记录 和生物数据。补充目标：通过本补充，我们将致力于更好地定义 招募和留住员工的社区障碍。我们还将制定减少这些壁垒的战略。 并增加招聘和留住促进员，并对他们进行测试。因此，我们提出了一个 补充办法的组合，包括通过每天的警察报告进行环境扫描 来自工作人员的报告、深入访谈和与社区成员的焦点小组讨论；然后 测试这些成功完成学习的新策略。拟议补编的具体目标是： 目标1.检查一系列暴力、吸毒模式和结构性条件的变化 作为登记、干预、参与和保留夫妇和社区的障碍 每个研究社区的成员。目标2.实现并测试对等导航器作为促进器 在CHC+和减少社区污名方面减少招募和参与的障碍 干预措施，并顺利完成后续预约。 公共卫生影响：COVID大流行挑战并使结束艾滋病毒的承诺复杂化。 失业，社区和帮派暴力事件增加，以及持续的大量药物使用，构成了 开普敦健康研究的参与者面临重大风险，停电对以下工作人员也是如此 正在使用基于社区的方法进行招聘。本附录有可能确定解决方案 并证明同龄人可以克服这些交叉障碍，成为他们的 社区安全地增加参与者在卫生研究干预中的招募和吸收。的确有 还有可能解决艾滋病毒护理的级联问题，以结束艾滋病毒，并将这些战略推广到其他区域 有更多草根和可持续的解决方案。

PROJECT SUMMARY/ABSTRACT The proposed supplement seeks to address barriers and test new facilitators for recruitment and uptake of PrEP and ART for the biobehavioral Couples Health CoOp Plus (CHC+) intervention, and for the stigma- reduction intervention at the structural level within communities. It is critical to note that the CHC+ parent study stigma intervention was originally awarded to take place in community clinics and has shifted to communities due to the COVID pandemic. With these changes, the CHC+ parent study is delayed as the project faces multiple daily barriers with recruitment that slow study progress, including documented community violence, protests, gang violence, and community unrest. The CHC+ team is also adjusting to continuous rolling power outages, which include not only electricity supply but also increased travel time caused by traffic lights being out, and reduced communication with participants caused by mobile network coverage blackouts. Additionally, there are continued high rates of substance use—including heavy alcohol, methamphetamine, and methaqualone with marijuana use—as documented in our preliminary behavioral and biological data. Supplement Goals: Through this supplement, we will aim to better define the community barriers for recruitment and retention. We will also develop strategies to reduce these barriers and increase facilitators for recruitment and retention, and to test them. Consequently, we propose a combination of supplementary approaches, including an environmental scan through police reports, daily reports from staff, in-depth interviews, and focus group discussions with community members; and then to test these new strategies for successful study completion. The proposed Supplement Specific Aims are: Aim 1. To examine how a constellation of violence, drug use patterns, and changes in structural conditions act as barriers to enrollment, intervention engagement, and retention of the couples and community members within each study community. Aim 2. To implement and test peer navigators as facilitators to reduce barriers to recruitment and engagement in both the CHC+ and Community Stigma reduction interventions and complete follow-up appointments successfully. Public Health Impact: The COVID pandemic has challenged and complicated the commitment to end HIV. The loss of jobs, increased community and gang violence, and persistent heavy substance use pose a significant risk for participants in health studies in Cape Town, as do power outages for staff members who are recruiting using community-based approaches. This supplement has the potential to identify solutions and prove that peers can overcome these intersectional barriers and become ambassadors within their communities to safely increase participant recruitment and uptake in health research interventions. There is also the potential to address the HIV care cascade to end HIV and translate these strategies to other regions with more grassroots and sustainable solutions.