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

为巴尔的摩寻求家庭暴力服务的妇女制定和评估 PrEP 决策援助

• 批准号: 10327004
• 负责人: Jaimie Meyer
• 金额: $ 26.3万
• 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/10327004
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adoption; Advocate; Affect; Area; Awareness; Baltimore; 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 determinants; 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是相互交织、相辅相成的流行病，对 黑人女性，特别是在美国南部。IPV使艾滋病毒的异性传播升级。暴露在IPV上 女性感染艾滋病毒的可能性是同龄人的四倍。感染了IPV的女性在 由于强迫和强迫与携带艾滋病毒的伴侣发生性行为、无避孕套的性行为、持久的性行为，感染艾滋病毒的风险更大 害怕安全性行为(避孕套)谈判和物质使用。男性IPV犯罪者更有可能患有 未经治疗的艾滋病毒，直接增加了妇女感染艾滋病毒的风险。为了应对艾滋病毒和IPV在美国的交集。 关于妇女，2020年国家艾滋病毒/艾滋病战略呼吁采取主动行动，“扩大公共宣传、教育和 预防艾滋病毒和其他相互交错的问题，如IPV。结束艾滋病毒流行(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， 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 这些区域。暴露前预防(PrEP)是一种用户控制的、有效的IPV-HIV预防策略。 暴露在黑人女性身上，但全国数据表明，与 男人。疾控中心概述了为妇女实施PrEP面临的两个挑战：(1)妇女的准确 评估他们个人和伴侣的艾滋病毒风险；以及(2)很少有环境提供PrEP介绍。知情者 决策辅助工具可以克服这些障碍，因为它们是以患者为中心的干预措施，可以增加 提高认识，重新定位个人风险评估，并使妇女能够做出知情的、基于价值观的 决定。家庭暴力(DV)机构的PrEP决策援助可以解决这些PrEP的执行问题 挑战。我们的第二类混合有效性-实施研究旨在调整现有的PrEP决策辅助 面向在马里兰州巴尔的摩寻求DV服务的暴露于IPV的黑人妇女，巴尔的摩是EHE的优先地区。自我和 将实施由倡导者管理的PrEP决策援助版本，并将使用 一项双臂随机试验，由实施研究综合框架(CFIR)指导。一个 通过对接触IPV的黑人妇女(N=20)和DV倡导者的定性访谈进行形成性评估 (n=10)将对现有的PrEP决策辅助工具进行调整。下一步，决策辅助将在 一个DV机构和60名接触IPV的黑人妇女将被随机分为自我管理或倡导管理 用于比较PrEP吸收的可行性、可接受性和初步有效性的援助版本 基线、1个月、3个月和6个月的调查。与DV倡导者一起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，以解决关键的艾滋病毒预防问题 接触IPV的黑人女性群体；使用实施科学来增加地理区域的PrEP接受率 马里兰州巴尔的摩的优先地区；将疾病预防机构纳入干预措施的制定和实施；以及 通过解决为接触IPV的黑人妇女服务的环境中的实施因素，向PrEP扩大规模提供信息。