A structural HIV prevention intervention targeting high-risk women

项目摘要 艾滋病毒流行30年来，世界各地的FSW中艾滋病毒/性传播感染率居高不下， 在美国对这一人群的研究很少。FSW经历了一系列独特的脆弱性 与诸如耻辱和不安全的工作环境等结构性因素有关。这些因素抑制了 保护性的性行为和寻求艾滋病毒检测、护理和治疗。艾滋病毒预防方法， 解决性工作者感染艾滋病毒的社会和结构脆弱性的工作已证明是有效的 国际吧然而在美国，艾滋病毒预防的结构性干预措施很少。我们的研究发现 广泛的结构性脆弱性，如无家可归、饥饿和暴力的高比率，以及 街头FSW的注射和非注射毒品使用率。我们目前在第四年的“A 针对高危女性的结构性艾滋病毒预防干预”（R 01 DA 041243）-“EMERALD”研究- 该项目的重点是制定和评估一种独特的、创新的结构性干预措施， 性工作者中艾滋病毒、性传播感染和问题药物使用的负担。我们要求补充资金， EMERALD队列招募和随访的实际和预计成本。简而言之， 与我们之前在FSW中进行的研究相比，保留费用明显高于预期， 巴尔的摩。目前，研究人群已被证明不太容易接触和跟踪- 这需要我们的现场工作人员投入更多的时间和精力。此外，死亡过量的比率增加， 巴尔的摩与当地和全国阿片类药物流行一致，正在影响我们的研究人群， sample.该补编的目的如下。第一，能够继续扩大（350至385名妇女） 并对EMERALD队列进行随访，以充分检查暴露于干预的影响（EMERALD队列）。 艾滋病毒/性传播感染危险行为的组成部分（例如，吸毒/无保护的性行为）和艾滋病毒/性传播感染累积 与对照组相比，干预组（n=225）中FSW随时间推移的发病率 （n=160）。其次，检查EMERALD队列（N=385）中非致死性和致死性药物过量的相关性 鉴于类阿片流行病导致的致命和非致命过量服用率高于预期。通过目标1， 所要求的补充将使我们能够扩大我们的样本，并加强后续工作， 鉴于需要更多的工作人员加紧努力，目标2将允许一个强大的 了解非致死性和致死性过量死亡，检查患病率、发生率、相关性， 以及自我报告的非致命性和确认的致命性过量的预测因子，后者通过 国家健康统计中心的国家死亡指数。

Project Summary Three decades into the HIV epidemic, high HIV/STI rates persist among FSWs throughout the world, and research on this population in the U.S. is scarce. FSWs experience a unique set of vulnerabilities associated with structural factors such stigma, and unsafe work environments. These factors inhibit protective sexual behaviors and seeking of HIV testing, care, and treatment. HIV prevention approaches that address social and structural vulnerabilities to HIV infection among FSWs have demonstrated effectiveness worldwide. Yet in the U.S., structural HIV prevention interventions are scarce. Our research has found extensive structural vulnerability such as high rates of homelessness, hunger, and violence, as well as high rates of injection and noninjection drug use among street-based FSWs. We are currently in the 4th year of “A structural HIV prevention intervention targeting high-risk women” (R01DA041243) – the “EMERALD” study - that focuses on developing and evaluating a unique and innovative structural intervention aimed to reduce the burden of HIV, STIs, and problematic drug use among FSW. We are requesting a supplement to support the actual and projected cost of the EMERALD cohort recruitment and follow-up. Briefly, recruitment and retention expenses are significantly higher than anticipated compared to our prior studies among FSW in Baltimore. At the current, time, the study population have proved to be less accessible to reach and to follow- up, which requires more time and effort from our field staff. Further, increasing rates of fatal overdose in Baltimore, consistent with the local and national opioid epidemic, are impacting our study population and sample. The supplement’s aims are the following. First, to enable continued expansion (350 to 385 women) and follow-up the EMERALD cohort to sufficiently examine the effect of exposure to intervention (SPARC Center) components on HIV/STI risk behaviors (e.g., drug use/unprotected sex), and HIV/STI cumulative incidence over time in FSWs in the intervention group (n=225) compared to those in the comparison group (n=160). Secondly, to examine correlates of nonfatal and fatal overdose in the EMERALD cohort (N=385) given higher than anticipated fatal and nonfatal overdose rates owing to the opioid epidemic. Through Aim 1, the requested supplement will allow us to both expand our sample as well as intensify follow-up efforts for the total study sample given the need for more staff intensive up efforts. Aim 2 will allow for a robust understanding of both nonfatal and fatal overdose deaths, examining the prevalence, incidence, correlates, and predictors of both self-reported nonfatal and confirmed fatal overdoses, the latter of which through the National Death Index from the National Center of Health Statistics.