Development and Evaluation of a PrEP Decision Aid for Women Seeking Domestic Violence Services in Baltimore

针对巴尔的摩寻求家庭暴力服务的妇女的 PrEP 决策援助的开发和评估

• 批准号: 10468296
• 负责人: Jaimie Meyer
• 金额: $ 24.71万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-11 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10468296
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adoption; Advocate; Affect; Area; Awareness; Baltimore; Black race; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Clinical Trials Design; Coercion; Cognitive; Collaborations; Communities; Connecticut; Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Decision Aid; Development; Disclosure; Disinhibition; Domestic Partners; Domestic Violence; Education; Effectiveness; Epidemic; Evaluation; Event; Focus Groups; Forcible intercourse; Fright; Gender; Geography; HIV; HIV Infections; HIV risk; Heterosexuals; Individual; Intervention; Interview; Link; Maryland; Mediation; Modification; Needs Assessment; Outcome; Pharmacotherapy; Population; Prevention; Prevention Research; Prevention program; Prevention strategy; Process; Provider; Public Health; Randomized; Randomized Clinical Trials; Reporting; Research; Risk; Risk Assessment; Safe Sex; Safety; Service setting; Services; Structure; Surveys; Testing; Time; Trauma; Unsafe Sex; Violence; Woman; arm; base; black women; cis-female; combat; condoms; effectiveness implementation study; empowered; evidence base; experience; formative assessment; implementation barriers; implementation context; implementation determinants; implementation evaluation; implementation outcomes; implementation process; implementation science; improved; innovation; interest; intimate partner violence; male; men; novel; outreach; patient oriented; perpetrators; pre-exposure prophylaxis; preference; preventive intervention; racial disparity; randomized trial; response; risk perception; scale up; service providers; sex; social stigma; substance use; therapy development; tool; transmission process; uptake; violence exposure

HIV and intimate partner violence (IPV) are intersecting, mutually-reinforcing epidemics that significantly affect Black women, particularly in the U.S. South. IPV escalates heterosexual transmission of HIV. IPV-exposed women are four-times more likely to be infected with HIV than their counterparts. IPV-exposed women are at greater risk for HIV infection due to forced and coerced sex with partners with HIV, condomless sex, enduring fear of safe sex (condom) negotiations and substance use. Male IPV perpetrators are more likely to have untreated HIV, directly increasing women’s HIV risk. In response to the intersection of HIV and IPV among U.S. women, the 2020 National HIV/AIDS Strategy calls for initiatives that “expand public outreach, education, and prevention efforts on HIV and other intersecting issues such as IPV.” The Ending the HIV Epidemic (EHE) Plan further emphasizes the need to increase HIV prevention in areas with high HIV burden, and there is an opportunity to increase uptake of partner-independent HIV prevention among IPV-exposed Black women in these areas. Pre-exposure prophylaxis (PrEP) is a user-controlled, effective HIV prevention strategy for IPV- exposed Black women, but national data indicates that PrEP is severely underutilized by women compared to men. The CDC has outlined two challenges to PrEP implementation for women: (1) women’s accurate assessment of their personal and partners’ HIV risk; and (2) few settings offer PrEP introductions. Informed decision aids can overcome these obstacles because they are patient-centered interventions that can increase PrEP awareness, reorient personal risk estimation, and empower women to make informed, values-based decisions. A PrEP decision aid in domestic violence (DV) agencies could address these PrEP implementation challenges. Our Type II hybrid effectiveness-implementation study seeks to adapt an existing PrEP decision aid to IPV-exposed Black women seeking DV services in Baltimore, Maryland, an EHE priority area. Self- and advocate-administered versions of the PrEP decision aid will be implemented and the aid will be evaluated using a two-arm randomized trial, guided by the Consolidated Framework for Implementation Research (CFIR). A formative evaluation using qualitative interviews with IPV-exposed Black women (N=20) and DV advocates (N=10) will be conducted to adapt the existing PrEP decision aid. Next, the decision aid will be implemented in a DV agency and 60 IPV-exposed Black women will be randomized to either the self- or advocate-administered versions of the aid to compare feasibility, acceptability and preliminary effectiveness at PrEP uptake with baseline, 1-, 3-, and 6-month surveys. Focus groups with DV advocates will assess for implementation process outcomes. This study will: provide support for a PrEP decision aid that addresses HIV prevention for the key population of IPV-exposed Black women; use implementation science to increase PrEP uptake in the geographic priority area of Baltimore, Maryland; include DV agencies in intervention development and implementation; and inform PrEP scale-up by addressing implementation factors in settings that serve IPV-exposed Black women.

艾滋病毒和亲密伴侣暴力 (IPV) 是相互交叉、相辅相成的流行病，严重影响 黑人女性，尤其是美国南部的黑人女性。 IPV 会加剧 HIV 的异性传播。 IPV暴露 女性感染艾滋病毒的可能性是女性的四倍。暴露于 IPV 的女性处于 由于强迫和胁迫与感染艾滋病毒的伴侣发生性行为、无安全套性行为、持久性行为，感染艾滋病毒的风险更大 害怕安全性行为（安全套）谈判和药物使用。男性 IPV 犯罪者更有可能患有 未经治疗的艾滋病毒，直接增加了女性感染艾滋病毒的风险。应对美国艾滋病毒和 IPV 的交叉传播 针对女性，2020 年国家艾滋病毒/艾滋病战略呼吁采取举措“扩大公共宣传、教育和 针对艾滋病毒和 IPV 等其他交叉问题的预防工作。”终结艾滋病毒流行 (EHE) 计划 进一步强调需要在艾滋病毒负担高的地区加强艾滋病毒预防，并且有 增加接触 IPV 的黑人妇女接受独立于伴侣的艾滋病毒预防的机会 这些领域。暴露前预防 (PrEP) 是一种用户控制的、有效的 HIV 预防策略，适用于 IPV- 接触过黑人女性，但国家数据表明，与黑人女性相比，女性对 PrEP 的利用严重不足 男人。 CDC 概述了针对女性实施 PrEP 的两大挑战：(1) 女性准确的 评估其个人和伴侣的艾滋病毒风险； (2) 很少有机构提供 PrEP 介绍。消息灵通 决策辅助可以克服这些障碍，因为它们是以患者为中心的干预措施，可以增加 PrEP 意识，重新定位个人风险评估，并赋予女性权力，让她们能够做出明智的、基于价值观的决策 决定。家庭暴力 (DV) 机构的 PrEP 决策援助可以解决这些 PrEP 的实施问题 挑战。我们的 II 型混合有效性实施研究旨在适应现有的 PrEP 决策辅助 向在马里兰州巴尔的摩（EHE 优先地区）寻求 DV 服务的接触 IPV 的黑人妇女提供服务。自我和 将实施 PrEP 决策援助的倡导者管理版本，并将使用以下方式评估该援助 一项以实施研究综合框架 (CFIR) 为指导的双臂随机试验。一个 通过对接触 IPV 的黑人女性 (N=20) 和家庭暴力倡导者进行定性访谈进行形成性评估 (N=10) 将进行调整现有的 PrEP 决策辅助。接下来，决策辅助将在 DV 机构和 60 名接触过 IPV 的黑人女性将被随机分配到自我管理组或倡导者管理组 比较 PrEP 实施的可行性、可接受性和初步有效性的援助版本 基线、1、3 和 6 个月调查。 DV 倡导者的焦点小组将评估实施过程 结果。这项研究将： 为 PrEP 决策援助提供支持，解决艾滋病毒预防的关键问题 接触 IPV 的黑人女性人口；利用实施科学来提高地区的 PrEP 接受率 马里兰州巴尔的摩的优先区域；让家庭暴力机构参与干预措施的制定和实施；和 通过解决为暴露于 IPV 的黑人女性提供服务的环境中的实施因素，为 PrEP 的扩大提供信息。