An effectiveness trial of WINGS+PrEP: a syndemic mHealth intervention to increase PrEP uptake among women impacted by heavy alcohol use and partner violence in the criminal legal system

项目总结 拟议的混合1型有效性和实施随机对照试验(RCT)将 评估旨在增加艾滋病毒预暴露的移动健康综合干预(WINGS PrEP) 社区监督项目(CSP)中妇女的预防(PrEP)启动和坚持 包括纽约市(NYC)世卫组织的缓刑、假释和替代监禁(ATI)计划 报告危险饮酒。迄今为止，很少有PrEP干预措施将重点放在顺性妇女身上，而且 没有人把CSP中的大量女性作为目标，由于种族主义的毒品法律，她们是 不成比例的黑人和拉丁裔。为CSP中的妇女推进有效的PrEP干预 承诺通过接触到不成比例的大量黑人和拉丁裔来减少艾滋病毒差距 仍然处于艾滋病毒高危状态的妇女。Prep为女性提供了一个独特的机会来从事 女性控制的艾滋病毒预防战略，这在危险饮酒的背景下至关重要 和暴力伴侣。然而，到目前为止，还没有基于证据的、以Syndemic为重点的PrEP干预措施 针对解决危险饮酒和IPV暴露问题的女性。拟议的研究干预 (WING PREP)是一项为期3个疗程的同步重点干预，它结合了基于证据的mHealth 酒精筛查、短期干预和转诊治疗(SBIRT)工具和循证研究 MHealth IPV SBIRT工具-带有基于证据的PrEP干预的翅膀，包括PrEP决策 利用新的同行导航和远程医疗组件提供帮助。将进行拟议的RCT 在CSP有300名妇女的情况下，符合条件的妇女将被随机分配到：(1)翼PrEP或(2)单独PrEP 这包括相同的基于证据的PrEP决策辅助与同行导航的单一会议。 这两个条件都将由财富协会提供，财富协会是一个基于社区的大型组织，为 CSP中的女性。重复评估将在基线以及干预后3、6和12个月进行。 这项研究将在保健公平的PRISM/RE-AIM(S)实施科学框架的指导下进行 并将研究多层次的背景因素如何影响覆盖范围、有效性、采用率 WINDS PrEP和PrEP的实施、维护和可持续性(RE-AIMS)以及如何 背景因素和进程可能相互作用，以促进或阻碍健康公平。如果找到WINDS PrEP 为了有效，它的低阈值格式被设计为在全国范围内扩大CSP设置，以遏制艾滋病毒 并减少受严重影响社区的妇女之间的艾滋病毒差距。

PROJECT SUMMARY The proposed hybrid type 1 Effectiveness and Implementation randomized controlled trial (RCT) will evaluate an m-Health syndemic intervention (WINGS+PrEP) that aims to increase HIV pre-exposure prophylaxis (PrEP) initiation and adherence among women in community supervision programs (CSPs) including probation, parole and alternative-to-incarceration (ATI) programs) in New York City (NYC) who report hazardous drinking. To date, very few PrEP interventions, have focused on cis-gender women, and none have targeted the large population of women in CSPs, who due to racialized drug laws, are disproportionately Black and Latinx. Advancing an effective PrEP intervention for women in CSPs holds promise for reducing HIV disparities by reaching a disproportionately large number of Black and Latinx women who remain at high risk for HIV. PrEP presents a unique opportunity for women to engage in a female-controlled HIV prevention strategy, which is vitally important within the context of hazardous drinking and violent partners. To date, however, there are no evidence-based syndemic-focused PrEP interventions for women that address hazardous drinking and IPV exposure. The proposed study intervention (WING+PrEP) is a 3-session syndemic focused intervention that combines an evidence-based mHealth Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT) tool, and an evidence-based mHealth IPV SBIRT tool - WINGS with an evidence-based PrEP intervention that includes a PrEP decision making aid with novel peer navigation and telemedicine components. The proposed RCT will be conducted with 300 women in CSPs Eligible women will be randomly assigned to: (1) WINGS+PrEP or (2) PrEP Alone that consists of the same evidence-based PrEP decision making aid single session with peer navigation. Both conditions will be delivered by Fortune Society a large community based organization that serves women in CSPs. Repeated assessments will occur at baseline and 3, 6, and 12-months post intervention. This study will be guided by the PRISM/RE-AIM(S) implementation science framework with a health equity lens and will examine how multilevel contextual factors may influence the reach, effectiveness, adoption, implementation, maintenance and sustainability (RE-AIMS) of WINGS+PrEP and PrEP and how these contextual factors and processes may interact to promote or impede health equity. If WINGS+PrEP is found to be effective, it's low threshold format is designed to be scaled up in CSP settings nationwide to curb HIV infection and to reduce HIV disparities among women from heavily impacted communities.