kINSHIP: Peer navigators addressing INtersectional Stigma to improve HIV Prevention among criminal-justice involved women

亲属关系：同伴导航员解决跨部门耻辱问题，以改善涉及刑事司法的妇女的艾滋病毒预防

• 批准号: 10400408
• 负责人: Emily F Dauria
• 金额: $ 1.41万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2021-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10400408
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; African American; Age; Awareness; Belief; Caring; Case Management; Clinical Medicine; Communities; Complex; Continuity of Patient Care; Criminal Justice; Data; Development; Discrimination; Epidemic; Face; Feedback; Focus Groups; Future; General Population; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV risk; Health system; High Risk Woman; Hispanics; Human immunodeficiency virus test; Imprisonment; Individual; Intervention; Intervention Studies; Interview; Justice; Knowledge; Latinx; Learning; Link; Medical; Mental Health; Minority Groups; Modeling; Newly Diagnosed; Participant; Patients; Population; Prevention; Prevention strategy; Preventive healthcare; Process; Provider; Public Health; Randomized; Recording of previous events; Reporting; Research; Research Design; Research Priority; Risk; Risk Behaviors; San Francisco; Services; Sex Behavior; Sexual Partners; Shapes; Stigmatization; Structure; System; Testing; Time; Training; Translations; Trauma; Trust; Underserved Population; United States; United States National Institutes of Health; Woman; Women' s Group; Work; acceptability and feasibility; barrier to care; base; behavior change; behavioral health; care systems; clinical care; control trial; design; effective intervention; efficacy testing; ethnic identity; ethnic minority population; experience; follow-up; health care availability; health care service; health disparity; high risk; improved; injection drug use; innovation; interest; intersectionality; intervention effect; medication compliance; multidisciplinary; navigator intervention; novel; peer; pilot trial; pre-exposure prophylaxis; prevention service; primary outcome; probation; programs; racial and ethnic; racial minority; randomized trial; screening; secondary outcome; sex; social stigma; standard of care; substance use; therapy development; trial comparing; uptake

Project Summary/Abstract – no change from original submission Stigma persists as a principle factor shaping HIV risk. Women involved in the criminal justice system have complex and highly stigmatized sexual and substance use risk profiles and are particularly vulnerable to, and experience, high rates of HIV. Pre-exposure prophylaxis, or PrEP, is an efficacious HIV prevention strategy, however, women at high-risk of HIV infection in the United States (US) are largely absent from national efforts to improve PrEP awareness and uptake. Criminal justice settings represent an important opportunity to address disparities in HIV by linking high-risk women, who experience multiple, intersecting stigmas with innovative biomedical HIV prevention strategies, like PrEP. Peer-led patient navigation interventions have demonstrated efficacy in building trust and reducing stigma and discrimination-related barriers to healthcare engagement, and hold strong potential to address multiple, intersecting stigmas and other multifactorial and complex barriers to PrEP acceptability, linkage, and uptake for criminal justice involved women. As a multidisciplinary team with expertise in HIV clinical medicine and care cascade research, intersectionality, stigma, and behavioral health (substance use, mental health and HIV prevention) interventions for justice-involved populations, we propose to develop and test a peer-led patient navigator PrEP linkage intervention for women at risk for HIV acquisition who are on probation in San Francisco. Intervention development and study design will be guided by our team’s pilot research, the Stigma and HIV Disparities Framework, and the PrEP Continuum of Care model. Study aims are to: 1) Determine the content and structure of a peer-led PrEP screening and linkage navigation intervention (Project kINSHIP) for high-risk CJI-women; 2) Refine and test the content and structure of the kINSHIP intervention for criminal justice involved women; and 3) Assess the feasibility, acceptability, and preliminary impact of the kINSHIP intervention on internalized stigma and the PrEP continuum of care in a pilot randomized trial. Formative qualitative work with key stakeholders, including women on probation, probation staff, and medical/public health staff in Aim 1 will guide intervention development and testing in Aim 2. In Aim 3, we will examine the primary outcome of PrEP service linkage and secondary outcomes such as time to linkage, PrEP prescription/initiation, and PrEP adherence/persistence. We will explore how intersectional stigma may moderate intervention effects on linkage to PrEP. The proposed study has the potential to: 1) reduce the impact of intersectional stigma as a barrier to service care engagement, 2) inform PrEP care continuum estimates for criminal justice-involved women as well as identify barriers, and 3) create an intervention suitable for large-scale efficacy testing and translation to other criminal justice settings.

项目概要/摘要-与最初提交的资料相比没有变化 耻辱感仍然是形成艾滋病毒风险的主要因素。参与刑事司法系统的妇女 复杂和高度污名化的性和药物使用风险状况，特别容易受到， 经验，高艾滋病毒感染率。暴露前预防（PrEP）是一种有效的艾滋病毒预防策略， 然而，在美国，艾滋病毒感染高危妇女基本上没有参与国家努力 提高PrEP意识和吸收。刑事司法环境是一个重要的机会， 通过将经历多重交叉耻辱的高危妇女与创新的艾滋病毒感染者联系起来， 生物医学艾滋病毒预防战略，如PrEP。同行领导的患者导航干预措施已经证明， 在建立信任和减少与耻辱和歧视相关的医疗保健参与障碍方面的有效性，以及 有很大潜力解决多重、交叉的污名和其他多因素和复杂的障碍， PrEP的可接受性、联系和刑事司法的吸收涉及妇女。作为一个多学科团队， 艾滋病毒临床医学和护理级联研究，交叉性，耻辱和行为健康方面的专业知识 （药物使用、心理健康和艾滋病毒预防）干预措施，我们建议 为有感染艾滋病毒风险的妇女开发和测试一种同行领导的患者导航PrEP联动干预措施 他们在旧金山弗朗西斯科缓刑干预开发和研究设计将由我们的 团队的试点研究，耻辱和艾滋病毒差异框架，以及PrEP连续护理模式。 研究目的是：1）确定同伴主导的PrEP筛查和链接导航的内容和结构 2）完善和测试《儿童与青少年健康计划》的内容和结构， 亲属关系干预刑事司法涉及妇女;和3）评估可行性，可接受性， KINSHIP干预对内化污名和试点中PrEP连续护理的初步影响 随机试验与关键利益攸关方，包括缓刑妇女， 目标1的医务/公共卫生人员将指导目标2的干预措施开发和测试。在目标3中， 我们将研究PrEP服务联系的主要结果和次要结果，如联系的时间， PrEP处方/启动和PrEP依从性/持续性。我们将探讨交叉污名如何 中度干预对PrEP关联的影响。拟议的研究有可能：1）减少影响 交叉污名作为服务护理参与的障碍，2）告知PrEP护理连续性估计， 参与刑事司法的妇女，以及确定障碍，和3）创建一个适合大规模的干预 效力测试和翻译到其他刑事司法环境。