Case Management Alternatives for African American Women at High Risk for HIV

项目描述（由申请人提供）：项目描述。该申请是NI DA资助# R01 DA13131的竞争更新，“吸毒女性性工作者的HIV/HCV/HBV简要干预”。这项研究的一项重要发现是，贫困的街头女性性工作者所经历的一些因素——包括童年创伤、吸毒、无家可归、街头生活、强奸和暴力受害——造成了这一人群中严重的健康问题。这些对迈阿密的非裔美国女性来说是最关键的，因为她们的经济资源水平较低，她们位于迈阿密最贫困和被忽视的社区，而且她们的艾滋病毒和其他性传播感染（STIs）的比例较高。尽管这些妇女面临无数的健康和社会问题，但许多障碍使她们无法寻求和获得所需的服务。这一竞争性更新的目的是试验旨在加强这一得不到充分服务的人口与药物滥用治疗和其他保健服务的联系和参与的创新办法。拟议应用的具体目的是：1)评估从迈阿密市中心内城社区招募的550名吸毒、贫困的非洲裔美国妇女样本的保健服务需求的性质和程度以及服务利用的障碍；2)实施两种替代性病例管理条件，旨在通过随机分配参与者，增加与适当卫生服务的联系和利用：一种基于优势/仅限专业的条件，在这种条件下，客户参与“基于优势”的病例管理方法；或者，一个基于优势/专业/同伴的情况下，一个由以下人员组成的团队：a)一个有资格的专业个案管理人员和b)一个正在康复的瘾君子/前性工作者-同伴-他们都接受过“基于优势”的个案管理技术培训-制定和促进服务计划的实施；3)通过对客户和提供者进行3个月和6个月的随访来评估这两种条件的有效性，以确定服务联系的程度和服务利用的结果，以及与服务获取相关的风险行为的变化；4)评估易感因素、使能因素和疾病/需求因素之间的相互作用模式，并在随访时检查它们对服务联系和参与的影响。与公共卫生相关。制定一个有效的机制，解决贫穷的吸毒非洲裔性工作者的保健和服务需要，将改善目标人口的健康状况和生活质量。此外，由于性工作者与多个性伴侣有接触，测试创新治疗方法和服务联系的研究有利于避免新的艾滋病毒/性传播感染，为已经感染的人提供更早获得医疗的机会，并减少这些感染向更广泛的人群传播。

DESCRIPTION (provided by applicant): Project Description. This application is a competing renewal of NI DA Grant # R01 DA13131, "Brief HIV/HCV/HBV Interventions for Drug-Using Women Sex Workers." An important finding of this study was that a number of factors experienced by indigent, street-based, women sex workers - including childhood trauma, drug use, homelessness, street life, rape and violent victimization -- contribute to serious health problems among this population. These are most critical among African-American women in Miami, given their lower levels of economic resources, their location in Miami's most impoverished and neglected communities, as well as their higher rates of HIV and other sexually transmitted infections (STIs). In spite of the myriad of health and social problems among these women, numerous barriers prevent them from seeking and accessing needed services. The purpose of this competing renewal is to test innovative approaches designed to increase linkages and engagement with drug abuse treatment and other health services among this underserved population. The specific aims of the proposed application are to: 1) assess the nature and extent of health service needs and barriers to service utilization among a sample of 550 drug-involved, indigent, African-American women recruited from inner city neighborhoods in downtown Miami; 2) implement two alternative case management conditions designed to increase linkages to, and utilization of, appropriate health services by randomly assigning participants to: a Strengths-Based / Professional Only Condition in which clients participate in a "strengths-based" case management approach; or, a Strengths-Based / Professional/Peer Condition in which a team composed of: a) a credentialed, professional case manager and b) a recovering addict/former sex worker-peer - both trained in "strengths-based" case management techniques - develop and facilitate the implementation of a service plan; 3) evaluate the effectiveness of these two conditions by conducting 3 and 6-month follow-ups with both clients and providers to determine extent of service linkages and outcomes of service utilization, as well as changes in risk behaviors as they relate to service access; and, 4) both across and between the two conditions, assess the patterns of interaction among predisposing, enabling, and illness/need factors, and examine their effects on services linkage and engagement at follow-up. Relevance to Public Health. Developing an effective mechanism for addressing the health and service needs of indigent drug-using African-American sex workers will improve the health status and the quality of life of the target population. In addition, because sex workers have contacts with multiple sexual partners, research that tests innovative approaches to treatment and service linkage has a benefit in terms of avoiding new HIV/STI infections, providing earlier access to medical treatment for those already infected, and reducing the spread of these infections to a wider population.