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.
This study intends to advance the science of HIV prevention by adapting a women-focused seek, test, treat, and retain (STTR) model for HIV prevention to include linkage to treatment for substance use and victimization. The public health impact is potentially far-reaching. First, linking and retaining high-risk young women in treatment for substance use and victimization is likely to positively impact their well-being which may improve their uptake of behavioral and biomedical HIV prevention strategies. Second, developing novel HIV prevention strategies for young women with multiple risk behaviors, among whom new HIV infections are concentrated, may reduce HIV incidence in South Africa. Finally, this project advances NIH?s goals of promoting research that addresses gender disparities in risks for HIV and identifying strategies for preventing HIV in most-at-risk populations.
| Myers, Bronwyn; Carney, Tara; Browne, Felicia A et al. (2018) Development of a trauma-informed substance use and sexual risk reduction intervention for young South African women. Patient Prefer Adherence 12:1997-2006 |
| 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 |
