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

项目摘要/摘要 耻辱仍然是影响艾滋病毒风险的主要因素。参与刑事司法系统的女性 复杂和高度污名化的性和物质使用风险概况，特别容易受到 经验表明，艾滋病毒感染率很高。暴露前预防，或PrEP，是一种有效的艾滋病毒预防策略， 然而，在美国，艾滋病毒感染的高危妇女在很大程度上没有参与国家努力 以提高对PrEP的认识和接受。刑事司法环境是解决以下问题的重要机会 通过将经历多重交叉污名的高危女性与创新的 生物医学艾滋病毒预防战略，如PrEP。同行主导的患者导航干预已经证明 在建立信任和减少与医疗保健参与相关的耻辱和歧视障碍方面的有效性，以及 有很强的潜力解决多重、交叉的耻辱和其他多因素和复杂的障碍 为刑事司法准备的可接受性、关联性和接受性涉及妇女。作为一个多学科团队， 艾滋病毒临床医学和护理方面的专业知识包括研究、交叉、污名和行为健康 (药物使用、心理健康和艾滋病毒预防)针对涉及司法的人群的干预措施，我们建议 为有感染艾滋病毒风险的妇女开发和测试同行主导的患者导航器PrEP连锁干预 目前正在旧金山缓刑。干预开发和研究设计将由我们的 该团队的试点研究、耻辱和艾滋病毒差异框架以及PrEP连续护理模式。 研究的目的是：1)确定同行主导的PrEP筛选和链接导航的内容和结构 对高危CJI-妇女的干预(项目亲属关系)；2)完善和测试 刑事司法中的亲属关系干预涉及妇女；以及3)评估可行性、可接受性和 亲属关系干预对飞行员内化耻辱和PrEP连续照护的初步影响 随机试验。与关键利益相关者进行形成性的定性工作，包括缓刑、缓刑妇女 目标1中的工作人员和医疗/公共卫生人员将指导目标2中的干预开发和测试。 我们将研究PrEP服务链接的主要结果和次要结果，如链接时间， 准备处方/启动，以及PrEP坚持/持久性。我们将探索跨部门的污名是如何 适度干预对PrEP连锁的影响。这项拟议的研究有可能：1)减少影响 跨部门污名是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识别障碍，以及3)创建适合大规模干预的干预 效力测试和翻译到其他刑事司法环境。

Project Summary/Abstract 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.