Combination Prevention for Vulnerable Women in South Africa.

在南非，据估计感染艾滋病毒的人比世界上任何其他地方都多，许多妇女为了生存而进行性交易，因此必须采取有针对性的循证战略，以接触到脆弱的妇女群体。为了实现RFA-DA11-001的目标，我们建议(1)扩大艾滋病毒检测以覆盖更多高危妇女，以便可以评估艾滋病毒阳性妇女是否被安排并保留接受抗逆转录病毒治疗(ART)，(2)评估针对HIV阳性和HIV阴性酒精及其他药物(AOD)使用的妇女的可持续预防做法，以及(3)衡量关于抗逆转录病毒疗法的开始、坚持、保留和降低风险行为的综合预防策略的有效性。我们提议的合作伙伴是职业发展基金会(FPD)，它是由PEPFAR资助的南非最大的运营项目之一。FPD负责一个医疗管理计划，支持全国9万名接受抗逆转录病毒治疗的患者。然而，FPD目前没有针对和接触使用AOD的弱势妇女，与我们在同一地区接触到AOD弱势妇女的前一项研究相比，仅检测到8.5%的艾滋病毒阳性，估计性工作者中艾滋病毒感染率为65%，非性工作者中艾滋病毒感染率为26%。基于对帮助一些最脆弱的南非妇女的迫切需求，我们建议与北卡罗来纳大学艾滋病研究中心的科学和医疗专业知识合作，结合我们的能力，提供一种组合预防方法，优化检测、治疗和保留(TTR)战略，以接触到高危、易受伤害、使用AOD的妇女。我们将使用地理分组随机设计来比较妇女健康合作(WHC)外展和干预计划-一个经过验证的以妇女为重点的增强型艾滋病毒预防战略，解决艾滋病毒阳性和阴性妇女的AOD使用、性危险行为、基于性别的暴力、赋权、技能培训和个性化行动计划-加上自愿咨询和检测(VCT)，并将VCT单独作为标准做法。以使用AOD的高危女性为目标，她们有多个伴侣，避孕套使用情况不佳，也会影响她们的其他伴侣，从而影响更广泛的社区。拟议研究的首要目标是确定这种针对特定高危群体的综合预防和强化战略是否比目前的标准做法更有效。拟议的联合预防干预措施是专门为接触到更多高危、易患AOD的妇女而设计的，并在现有的实施方案中进行测试。如果这种以妇女为重点的综合预防干预措施被证明是有效的，它很有可能得到广泛实施，并通过降低南非极高的艾滋病毒发病率而对公共卫生产生重大影响。

DESCRIPTION (provided by applicant) In South Africa, where it is estimated that more people have HIV than anywhere else in the world and where many women trade sex in order to survive, targeted evidence-based strategies to reach vulnerable populations of women are essential. To address the objectives of RFA-DA11-001, we propose to (1) expand HIV testing to reach more at-risk women so that HIV-positive women can be evaluated to be placed and retained on antiretroviral therapy (ART), (2) assess sustainable woman-focused prevention practices for both HIV-positive and HIV-negative alcohol and other drug (AOD)-using women, and (3) measure the effectiveness of a combined prevention strategy on ART initiation, adherence, retention, and reduced risk behavior. Our proposed partner, the Foundation for Professional Development (FPD), is one of the largest PEPFAR-funded operational programs in South Africa. FPD is responsible for a medical management program supporting 90,000 patients on ART across the country. However, FPD does not currently target and reach vulnerable AOD-using women, detecting only 8.5% HIV positive compared with our previous study in the same region reaching vulnerable AOD-using women, with an estimated HIV prevalence of 65% among sex workers and 26% among non-sex workers. Based on this critical need to reach some of the most vulnerable South African women, we propose to combine our capabilities, in collaboration with scientific and medical expertise from the UNC Center for AIDS Research, to provide a combination prevention approach that optimizes the test, treat, and retain (TTR) strategy to reach high-risk, vulnerable, AOD-using women. We will use a geographically clustered randomized design to compare the Women's Health CoOp (WHC) outreach and intervention program - a proven woman-focused enhanced HIV prevention strategy that addresses AOD use, and sex risk behaviors, gender-based violence, empowerment, skills training, and personalized action plans for both HIV-positive and HIV-negative women - plus voluntary counseling and testing (VCT), with VCT alone as standard practice. Targeting most-at-risk women who use AODs, who have multiple partners, and who have poor condom practices, will also impact their other partners and thus the wider community. The overarching goal of the proposed research is to determine whether this combined prevention and enhanced strategy targeting a specific at-risk group is more effective than current standard practices. The proposed combination prevention intervention is designed specifically to reach more at-risk vulnerable AOD-using women and be tested in an existing implementation program. If this combination woman-focused prevention intervention proves efficacious, there is a high likelihood that it can be widely implemented and have a substantial public health impact by reducing the exceedingly high HIV incidence in South Africa.