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

项目总结/摘要 在南非，艾滋病毒感染率最高的是年轻妇女，其中许多人与性伴侣有关系。 一个主要的合作伙伴，其中酒精和其他药物（AOD）的使用是常见的，除了他们之间， 无安全套性行为、外部性伴侣和基于性别的暴力。许多年轻女性和她们的 伴侣处于青年期，这是一个性风险的关键时期。拟议订正 需要采取全面的预防和治疗办法来处理这些交叉流行病。我们 建议修改我们对开普敦年轻夫妇的循证夫妇干预。 拟议的夫妇健康CoOp Plus（CHC+）生物行为干预将包括以下信息： 以及与PrEP和ART的联系。我们还将完善诊所减少耻辱的培训，以解决 对使用AOD和寻求艾滋病毒服务的年轻人的态度和行为进行污名化。我们 提出了一个多层次的方法，通过一个集群随机试验与修改析因设计，其中24 诊所被随机分为接受减少耻辱培训和不接受培训两组。从诊所集水区 在经济贫困地区，我们将使用NIDA的寻找，测试，治疗和保留 范例寻求480对夫妇（18至30岁）。集水区的诊所将被随机分配接受艾滋病毒治疗 测试服务（HTS）和/或CHC+。早期的一项研究证明了夫妇之间的有效性。 对AOD使用、性风险、性别角色和艾滋病毒发病率进行干预，但未纳入ART和PrEP （治疗）;也没有将其纳入诊所，以解决提供服务中的污名问题（治疗和保留）。 具体目标是：目标1。修改CHC干预措施，将ART/PrEP纳入形成阶段 并与我们的社区合作委员会和同行咨询委员会的审查。目标2.评价 减少污名培训对诊所工作人员对年轻女性的态度和行为的影响， 寻求艾滋病毒服务（检测/抗逆转录病毒疗法/预防性治疗）和其他性和生殖服务的主要男性伴侣 在6个月和12个月时与诊所工作人员一起提供保健服务。目标3。为了测试CHC+的功效， 合作伙伴的PrEP/ART启动和坚持（在3，6，9和12个月），并减少AOD使用，性风险 和性别暴力，并加强积极的性别规范和沟通相对于HTS（在6个月和12个月）。 目标4。通过混合方法研究减少污名培训和CHC+在 增加年轻女性及其主要受试者的PrEP和ART启动，保留和坚持 伙伴 如果这种多层次的方法证明在增加PrEP和ART的启动，依从性和 保留，它可以帮助实现不可检测=不可传输（U=U）的目标。如果成功，该项目 可以帮助南非和美国政府确定新的方法来扩大 对有感染艾滋病毒风险的年轻夫妇进行艾滋病毒预防和护理的连续性。

PROJECT SUMMARY/ABSTRACT The highest HIV incidence in South Africa is among young women, many of whom are in relationships with a primary partner in which alcohol and other drug (AOD) use is common between them, in addition to condomless sex, outside sex partners, and gender-based violence (GBV). Many young women and their partners are in young adulthood, a critical period characterized by sexual risk. The proposed revised comprehensive prevention and treatment approach is needed to address these intersectional epidemics. We propose to modify our evidence-based couples' intervention for young couples in Cape Town. The proposed Couples' Health CoOp Plus (CHC+) biobehavioral intervention will include information about and linkage to PrEP and ART. We also will refine a stigma-reduction training for clinics to address stigmatizing attitudes and behaviors toward young people who use AODs and seek HIV services. We propose a multilevel approach through a cluster randomized trial with a modified factorial design whereby 24 clinics are randomized to receive either stigma-reduction training or no training. From the clinic catchment areas in economically disadvantaged communities, we will use NIDA's Seek, Test, Treat and Retain paradigm to seek 480 couples (aged 18 to 30). Clinics in catchment areas will be randomized to receive HIV testing services (HTS) and/or the CHC+. An earlier study demonstrated the efficacy of the couples' intervention on AOD use, sex risk, gender roles and HIV incidence, but it did not incorporate ART and PrEP (treat); nor was it integrated into clinics to address stigma in service provision (treat and retain). The Specific Aims are: Aim 1. To modify the CHC intervention to include ART/PrEP in a formative phase and with review from our Community Collaborative Board and a Peer Advisory Board. Aim 2. To evaluate the impact of a stigma-reduction training on clinic staffs' attitudes and behaviors toward young women and their primary male partner seeking HIV services (testing/ART/PrEP) and other sexual and reproductive health services with clinic staff at 6 and 12 months. Aim 3. To test the efficacy of the CHC+ to increase both partners' PrEP/ART initiation and adherence (at 3, 6, 9, and 12 months), and reduce AOD use, sexual risk and GBV, and enhance positive gender norms and communication relative to HTS (at 6 and 12 months). Aim 4. To examine through mixed methods the interaction of the stigma-reduction training and the CHC+ on increased PrEP and ART initiation, retention, and adherence among young women and their primary partners. If this multilevel approach demonstrates efficacy in increasing PrEP and ART initiation, adherence and retention, it could help achieve the Undetectable=Untransmittable (U=U) goals. If successful, the project could help the governments of South Africa and the United States identify new approaches to expanding the HIV continuum of prevention and care among young couples at risk for HIV.