For HIV prevention efforts to be most effective they must reach populations most at risk, use efficacious interventions, and be deliverable in real-world settings. While many efficacious evidence-based interventions (EBIs) for HIV prevention currently exist, community-based organizations (CBOs) often have difficulties implementing them among those most likely to benefit, with fidelity, good effect, and sustainability. Structural factors related to poverty often hinder HIV prevention delivery in communities most in need of the programs. For CBOs to successfully prevent the transmission of HIV in high risk communities, strategies to overcome the challenges of implementation are needed. Community-based participatory research (CBPR) offers one approach to work with community members to pinpoint community resources, priorities, needs, and barriers to consider in implementation. This application explores these issues among an often under-recognized group at enormously increased risk of HIV: African American women in the US South. The South is disproportionately affected by the HIV epidemic, with incidence rising over the last decade, and the largest burden on African Americans and women. HIV burden in women has also grown the past 25 years from 8% to over 25% of US AIDS cases. While African American women are only 12% of US women, they comprise 64% of newly infected women. Compounding the great need represented by these disparities, in previous studies, African American women in North Carolina reported significant structural obstacles to accessing HIV prevention programs in their communities, such as lack of transportation and childcare, food insecurity, and competing demands and suggested that program delivery in or near public housing facilities may represent a feasible way to overcome some of these barriers in locations where many people at elevated risk of HIV are concentrated. In a unique, transdisciplinary collaboration between UNC, CAARE, and the Durham Housing Authority, the central objective of this application is to design a structurally-informed implementation program plan for sustainable HIV prevention in public housing developments, using the Real AIDS Prevention Program EBI for African American women, as a test-case model in three aims. We will 1) Engage a broad range of community stakeholders to participate in the design of study methods and adaptation of RAPP for women living in public housing developments in the southern US through CBPR methods; 2) Understand perceived community resources, needs, priorities, and obstacles to the implementation of HIV prevention programs, particularly RAPP, among DHA residents and DHA and CAARE staff; 3) Create a replicable program plan for implementing RAPP within southern housing authority developments and pilot-test the implementation plan within the DHA for fidelity, feasibility, and acceptability.If successful, our next step will be to test the implementation program plan more widely at multiple southern US sites in an R01 application.
This project seeks to identify effective methods for implementing evidence-based HIV prevention programs for African American women in real-world settings in the rural south. It represents a partnership between community based organizations and the academic center to use community-based participatory research approaches. The proposed project is highly relevant to public health because it will help further understanding of how to implement high-quality evidence-based HIV prevention interventions in vulnerable communities.
