Linking high-risk young women to HIV prevention and care for comorbid conditions

 描述(申请人提供)：在南非西开普省，艾滋病毒正在增加，新的感染主要发生在来自贫困社区的年轻妇女中。在这一人群中，药物使用和受害是艾滋病毒风险的关键驱动因素，但这些情况很少得到治疗。由于未经治疗的药物使用和受害对艾滋病毒预防工作产生负面影响，必须扩大对年轻妇女的艾滋病毒预防工作，将与治疗这些并存疾病的联系包括在内。寻求、检测、治疗和保留方法已被用于让高危人群参与艾滋病毒预防和治疗，但尚未被用作让高危年轻妇女参与艾滋病毒预防和治疗的模式，以预防和治疗同时发生的药物使用和受害。该项目的目标是通过调整以妇女为重点的性传播技术艾滋病毒预防模式来弥补这一差距，以包括与药物使用和受害服务的联系。利用Adapt-ITT框架指导干预适应，我们将首先深入访谈有药物使用障碍和受害经历的年轻女性的保健提供者和焦点群体，以探讨她们对年轻女性参与和保留艾滋病毒、药物使用和受害服务的障碍的看法。调查结果将指导关于如何调整妇女健康合作组织的决定，这是一种预防艾滋病毒的STTR模式，以促进与药物使用和受害治疗的联系。接下来，我们将对高危年轻女性进行一系列焦点小组的适应性干预。调查结果将被用来进一步调整该模型，以提高目标人群的相关性、适合性和可接受性。最后，我们将通过在选定的社区通过街头外展寻找60名高危年轻女性，并将这些年轻女性招募到STTR干预中，在那里对她们进行艾滋病毒、怀孕和最近的药物使用测试，并评估与受害和艾滋病毒危险行为有关的创伤，以测试这种经过调整的艾滋病毒预防模式的初步可行性。然后，他们将接受艾滋病毒预防干预，其中包括药物使用和受害治疗的准备和联系。在接受最后一次干预课程后，他们将立即完成简短的评估。此后，参与者将获得案例管理服务，这些服务为服务使用提供持续支持，并针对留住服务的结构性障碍。将在最后一次评估后三个月对参与者进行评估，以审查该模式是否有可能促进与药物使用和受害服务的联系。

 DESCRIPTION (provided by applicant): HIV is increasing in the Western Cape province of South Africa, with new infections occurring mostly among young women from poor communities. Substance use and victimization are key drivers of risk for HIV in this population, yet these conditions are rarely treated. As untreated substance use and victimization negatively impact on the uptake of HIV prevention, it is imperative to expand HIV prevention for young women to include linkage to treatment for these co-occurring conditions. Seek, test, treat and retain (STTR) approaches have been used to engage high-risk populations in HIV prevention and treatment, but have not yet been used as a model for engaging high-risk young women in HIV prevention and treatment for co-occurring substance use and victimization. The goal of this project is to address this gap by adapting a women-focused STTR HIV prevention model to include linkage to substance use and victimization services. Using the ADAPT-ITT framework to guide intervention adaptation, we will first conduct in-depth interviews with health providers and focus groups with young women with substance use disorders and victimization experiences to explore their perceptions of barriers to engagement and retention in services for HIV, substance use and victimization among young women. Findings will guide decisions about how to adapt the Women's Health CoOp, an STTR model for HIV prevention, to facilitate linkage to treatment for substance use and victimization. Next, we will administer the adapted intervention in a series of focus groups with high-risk young women. Findings will be used to further adapt the model to enhance relevance, fit, and acceptability for the target population. Finally, we will test the inital feasibility of this adapted STTR model for HIV prevention by seeking 60 high-risk young women through street outreach in selected communities and enrolling these young women into the STTR intervention where they will be tested for HIV, pregnancy and recent substance use and assessed for trauma related to victimization and HIV risk behavior. They will then receive the HIV prevention intervention that includes preparation and linkage to treatment for substance use and victimization. Immediately after receiving the last intervention session, they will complete a brief assessment. Thereafter, participants will receive case management services that provide ongoing support for service use and target structural barriers to retention in services. Participants will be assessed three months after the last assessment to examine whether the model has the potential for facilitating linkage to substance use and victimization services.