Development and Pilot Testing of a Mental Health Clinic-Based PrEP Uptake and Adherence Intervention for Women in Treatment for Trauma-Related Conditions

暴露前预防（PrEP）是一种非常有效的艾滋病毒预防工具，但妇女并不广泛使用。妇女 在美国南部，每年的艾滋病诊断占55%，暴力和创伤一直与之相关。 这些妇女感染艾滋病毒的风险增加。长期目标是建立一种新的治疗模式， 将生物医学艾滋病毒预防服务纳入精神卫生保健环境，从而消除个人和提供者- 为患有创伤相关疾病的妇女提供PrEP护理的水平障碍，这些妇女通过有问题的 物质使用或危险的性行为。总体目标是：（一）阐明个人和供应商层面的障碍， PrEP吸收和坚持，并在信息-动机-行为技能（IMB）模型的指导下，（ii）建立一个 基于心理健康诊所的行为干预，以增加该人群的PrEP吸收和依从性。的 中心假设是，与标准治疗相比，在心理健康治疗中提供的干预 整合知识，行为技能和参与和坚持PrEP护理的动机的设置将导致 更大比例的参与者填写他们的第一个PrEP处方。在第一年，我们将进行1A阶段的研究， 确定在制定综合治疗方案时要解决的关键问题。访谈数据来自接受手术的妇女 创伤相关疾病的心理健康治疗及其治疗提供者将用于完成 试点试验（第1B阶段），比较标准治疗与综合治疗（心理健康治疗和艾滋病毒预防） 干预新的综合干预措施将包括由IMB模式指导的动机咨询， 通过信息共享，增加改变的动机和教授行为技能来影响行为改变， 提高自我效能。为了检验这一假设，将追求以下具体目标： 关于PrEP使用的知识和态度，并获得有关综合行为的潜在设计的反馈 对正在接受创伤相关疾病治疗的妇女进行干预，这些妇女有感染艾滋病毒的风险;以及（2） 制定综合行为干预措施，以促进正在接受PrEP治疗的女性的PrEP吸收和依从性 （3）评估艾滋病毒感染高危人群的创伤相关情况的可行性、可接受性和初步疗效。 干预申请人认为，本申请中提出的研究具有创新性，因为心理健康 治疗环境的理想位置是提供额外的艾滋病毒预防服务，包括PrEP，但我们的 然而，尚未评估将PrEP服务充分纳入妇女心理健康治疗的情况。的 研究是重要的，因为它预计将提供科学的理由，继续发展， 针对经历过创伤的妇女的独特需求采取的行为干预措施。最终，此类研究 可以为制定创新战略提供信息，以提高对有效艾滋病毒预防战略的接受程度。

Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool but is not widely accessed by women. Women in the southern United States account for 55% of annual HIV diagnoses, and violence and trauma are consistently linked with increased HIV risk in these women. The long-term goal is to establish a new treatment delivery model that integrates biomedical HIV prevention services into mental health care settings, thus removing individual and provider- level barriers to PrEP care for women with trauma-related conditions who are at risk for HIV through problematic substance use or risky sexual behaviors. The overall objectives are to (i) elucidate individual and provider level barriers to PrEP uptake and adherence and, guided by the Information-Motivation-Behavioral Skills (IMB) model, (ii) establish a mental health clinic-based behavioral intervention for increasing PrEP uptake and adherence in this population. The central hypothesis is that, compared to standard treatment, an intervention delivered within the mental health treatment setting that integrates knowledge, behavioral skills, and motivation to engage in and adhere to PrEP care will result in a greater proportion of participants who fill their first PrEP prescription. In Year 1, we will conduct Stage 1A research to identify key issues to address in developing the integrated treatment. Interview data obtained from women undergoing mental health treatment for trauma-related conditions and their treatment providers will be used to finalize the design of the pilot trial (Stage 1B) comparing standard treatment to the integrated (mental health treatment and HIV prevention) intervention. The new integrated intervention will include motivational counseling guided by the IMB Model which seeks to influence behavior change via information sharing, increasing motivation for change, and teaching behavioral skills to increase self-efficacy. To test the hypothesis, the following specific aims will be pursued: (1) Collect information on knowledge and attitudes about PrEP use and obtain feedback about the potential design of the integrated behavioral intervention from women undergoing treatment for trauma-related conditions who are at risk for HIV and their; and (2) Develop an integrated behavioral intervention to promote PrEP uptake and adherence in women undergoing treatment for trauma-related conditions who are at high risk for HIV; and (3) Assess feasibility, acceptability and initial efficacy of the intervention. The research proposed in this application, in the applicant’s opinion, is innovative in that the mental health treatment setting is ideally situated to provide additional services for HIV prevention including PrEP but, to our knowledge, full integration of PrEP services into mental health treatment for women has not been evaluated. The research is significant because it is expected to provide scientific justification for the continued development of behavioral interventions tailored to the unique needs of women who have experienced trauma. Ultimately, such research can inform the development of innovative strategies to improve uptake of effective HIV prevention strategies.