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

针对治疗创伤相关疾病的女性，开发和试点基于心理健康诊所的 PrEP 摄取和依从性干预措施

• 批准号: 10441606
• 负责人: Ronald E. Acierno
• 金额: $ 23.4万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10441606
• 关键词: AIDS prevention; Address; Adherence; Adult; Attitude; Behavior; Behavior Therapy; Behavioral; Caring; Client; Clinic; Combined Modality Therapy; Counseling; Data; Development; Educational Materials; Educational process of instructing; Enrollment; Feedback; Goals; HIV; HIV diagnosis; HIV risk; Health; Health Personnel; Health Promotion; Health Service Area; Health Services Research; Healthcare Systems; Improve Access; Individual; Intervention; Interview; Knowledge; Link; Manuals; Mental Health; Mental Health Services; Mission; Modeling; Morbidity - disease rate; Motivation; Nurse Practitioners; Outcome; Participant; Patient Self-Report; Population; Prevention; Prevention Research; Prevention strategy; Provider; Psychiatric Nursing; Psychotherapy; Public Health; Recording of previous events; Research; Risk; Self Efficacy; Services; Suggestion; System; Tenofovir; Testing; Trauma; Treatment Efficacy; United States; United States National Institutes of Health; Urine; Ursidae Family; Violence; Woman; Women' s Group; base; behavior change; behavior influence; cis-female; design; evidence base; experience; health care settings; high risk; high risk sexual behavior; improved; innovation; mortality; pilot test; pilot trial; pre-exposure prophylaxis; prevention service; provider-level barriers; satisfaction; service delivery; skills; skills training; social; social stigma; standard care; substance use; therapy design; tool; transmission process; trauma care; trauma exposure; uptake; willingness

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.

暴露前预防（PREP）是一种非常有效的HIV预防工具，但并未被女性广泛使用。 在美国南部，占年HIV诊断的55％，暴力和创伤始终是联系的 这些妇女的艾滋病毒风险增加。长期目标是建立一种新的治疗交付模型 综合生物医学艾滋病毒预防服务纳入心理保健环境中，从而删除个人和提供者 - 针对患有创伤相关疾病的妇女的准备护理的水平障碍，这些妇女有问题有艾滋病毒的风险 物质使用或有风险的性行为。总体目标是（i）阐明个人和提供者级别的障碍 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措施，以增加该人群的预付款和依从性。这 中心假设是，与标准治疗相比，心理健康治疗中提供的干预措施 设置集成知识，行为技能和参与和遵守准备护理的动力的设置将导致 填写第一次准备处方的参与者比例更大。在第一年，我们将进行1A阶段研究 确定在开发综合治疗时要解决的关键问题。从经历的妇女那里获得的访谈数据 针对创伤相关疾病及其治疗提供者的心理健康治疗将用于最终设计 试点试验（第1B期）将标准处理与综合治疗（心理健康治疗和HIV预防）进行比较 干涉。新的综合干预措施将包括以IMB模型为指导的激励性咨询 通过信息共享来影响行为改变，增加变革的动力以及教学行为技巧 提高自我效能。为了检验假设，将追求以下具体目标：（1）收集有关的信息 知识并参与准备准备并获得有关综合行为的潜在设计的反馈 接受受到艾滋病毒及其风险的创伤相关疾病的妇女的干预； （2） 制定综合行为干预措施，以促进接受治疗的妇女的准备和遵守 与艾滋病毒高风险的与创伤有关的疾病； （3）评估可行性，可接受性和初始效率 干涉。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 理想情况下，治疗设置是为预防艾滋病毒提供的其他服务，包括PREP，但给我们 尚未评估知识，将准备服务完全整合到女性心理健康治疗中。这 研究之所以重要，是因为预计将为持续发展提供科学理由 根据经历过创伤的女性的独特需求量身定制的行为干预措施。最终，这样的研究 可以告知开发创新策略，以改善有效的艾滋病毒预防策略的吸收。