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.

Public Health Relevance

There is growing recognition that no single strategy will be sufficient to eliminate HIV transmission. In light of evidence that neither existing biomedical interventions nor any existing behavioral interventions will be sufficient to control the HIV epidemic in South Africa, the proposed study will combine a biomedical intervention (i.e., testing, treating, retention) with an evidence-based behavioral intervention (i.e., the Women's Health CoOp) to maximize the efficacy of both strategies. The proposed combination prevention intervention is designed specifically to reach more at-risk vulnerable alcohol and other (AOD) drug using women and be tested in an existing implementation program. If this combination intervention proves efficacious, there is a high likelihood that it can be widely implemented, be sustainable and have a substantial public health impact by reducing the exceedingly high HIV incidence in South Africa.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA032061-02
Application #
8302230
Study Section
Special Emphasis Panel (ZDA1-NXR-B (06))
Program Officer
Lloyd, Jacqueline
Project Start
2011-07-15
Project End
2016-04-30
Budget Start
2012-05-01
Budget End
2013-04-30
Support Year
2
Fiscal Year
2012
Total Cost
$783,804
Indirect Cost
$201,904
Name
Research Triangle Institute
Department
Type
DUNS #
004868105
City
Research Triangle
State
NC
Country
United States
Zip Code
27709
Zule, William A; Speizer, Ilene S; Browne, Felicia A et al. (2018) Condom Use, Multiple Rounds of Sex, and Alcohol Use Among South African Women Who Use Alcohol and Other Drugs: An Event-Level Analysis. Sex Transm Dis 45:786-790
Wechsberg, Wendee M; van der Horst, Charles; Ndirangu, Jacqueline et al. (2017) Seek, test, treat: substance-using women in the HIV treatment cascade in South Africa. Addict Sci Clin Pract 12:12
Chandler, Redonna; Gordon, Michael S; Kruszka, Bridget et al. (2017) Cohort profile: seek, test, treat and retain United States criminal justice cohort. Subst Abuse Treat Prev Policy 12:24
Wechsberg, Wendee M; Peasant, Courtney; Kline, Tracy et al. (2017) HIV Prevention Among Women Who Use Substances And Report Sex Work: Risk Groups Identified Among South African Women. AIDS Behav 21:155-166
Nance, Robin M; Delaney, J A Chris; Golin, Carol E et al. (2017) Co-calibration of two self-reported measures of adherence to antiretroviral therapy. AIDS Care 29:464-468
Myers, Bronwyn; Carney, Tara; Wechsberg, Wendee M (2016) ""Not on the agenda"": A qualitative study of influences on health services use among poor young women who use drugs in Cape Town, South Africa. Int J Drug Policy 30:52-8
Wechsberg, Wendee M; Deren, Sherry; Myers, Bronwyn et al. (2015) Gender-Specific HIV Prevention Interventions for Women Who Use Alcohol and Other Drugs: The Evolution of the Science and Future Directions. J Acquir Immune Defic Syndr 69 Suppl 2:S128-39
Syvertsen, Jennifer L; Robertson Bazzi, Angela M; Scheibe, Andrew et al. (2014) The promise and peril of pre-exposure prophylaxis (PrEP): using social science to inform prep interventions among female sex workers. Afr J Reprod Health 18:74-83
Wechsberg, Wendee M; Zule, William A; Ndirangu, Jacqueline et al. (2014) The biobehavioral Women's Health CoOp in Pretoria, South Africa: study protocol for a cluster-randomized design. BMC Public Health 14:1074