New Research to Reduce HIV with Vulnerable Women

RESEARCH TRIANGLE PARK, N.C.—As part of the ongoing effort to reduce HIV transmission in South Africa and improve prevention strategies, researchers at RTI International will conduct a study that will combine a biomedical intervention such as HIV testing, treatment, and retention with an adapted and proven evidence-based behavioral intervention to maximize the efficacy of both strategies.

The $3.9 million grant from the U.S National Institute on Drug Abuse (NIDA) will recruit black African women aged 15 or older from Pretoria, South Africa, who report recent unprotected sex and alcohol and other drug use.

The overarching goal of this new study is to determine whether this combined biobehavioral strategy targeting a specific at-risk group like sex workers is more effective than current standard practices.

"There is evidence that it is imperative to combine biomedical interventions like antiretroviral drugs with behavioral interventions to control the HIV epidemic in South Africa," said Wendee Wechsberg, Ph.D., senior director of RTI International's Substance Abuse Treatment Evaluations and Interventions Program. "There is a need for South Africa's current approach to HIV testing and treatment to be coupled with more targeted efforts that reach segments of the population that are at great risk for HIV."

The study will use the Women's Health CoOp as the behavioral intervention. The Women's Health CoOp, which was developed by Wechsberg, is a woman-focused, enhanced HIV prevention strategy that has been used with several domestic at-risk populations and was found to be a "best-evidence" HIV behavioral intervention by the Centers for Disease Control and Prevention.

Wechsberg developed and tested the original woman-focused intervention for crack-using African-American women in North Carolina. She then adapted the intervention in South Africa, where it has been successful in reducing HIV risk behaviors, reducing substance abuse and gender-based violence, and empowering women in several regions in South Africa for the past 10 years.

As part of the study, RTI will partner with the Foundation for Professional Development in South Africa and the University of North Carolina Center for AIDS Research to assess whether the Women's Health CoOp outreach strategies result in reaching more alcohol- and other drug-using women and identifying more HIV-positive women than do the standard voluntary counseling and testing methods in South Africa.

Additionally, this study will investigate whether adding the Women's Health CoOp to standard voluntary counseling and testing methods and PEPFAR practices results in more HIV-positive alcohol- and drug-using women getting medical evaluation, starting treatment, and staying in treatment while reducing risk behaviors.

The new study also will work to understand ways to increase the efficiency and effectiveness of HIV interventions by combining biomedical and behavioral approaches, using mobile units to reach vulnerable women, and adding case management to increase the proportion of women who participate and follow through with treatment, among others.

Pretoria and the surrounding area have been targeted for this study because of its continued high prevalence of HIV among childbearing women and a high prevalence of female sex workers.

A study conducted by Wechsberg in Pretoria found that, despite HIV prevalence of more than 60 percent among female sex workers in many areas and more than 30 percent among many alcohol- and drug-using women, most current HIV testing and treatment programs do not reach these women.

"If this combination intervention proves efficacious, there is a high likelihood that it can be widely implemented and have a substantial public health impact by reducing the viral load in the community and therefore new incidence in South Africa," Wechsberg said.