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: 10649451
• 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 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649451
• 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; Equity; Feedback; Goals; HIV; HIV diagnosis; HIV risk; Health; Health Personnel; Health Promotion; Health Service Area; Health Services Research; 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; Research Priority; Risk; Risk Reduction; Self Efficacy; Services; Suggestion; System; Tenofovir; Testing; Trauma; Treatment Efficacy; United States; United States National Institutes of Health; Urine; Violence; Woman; Women' s Group; Writing; acceptability and feasibility; behavior change; behavior influence; care systems; cis-female; design; evidence base; experience; health care settings; high risk; high risk sexual behavior; improved; innovation; knowledge integration; 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）是一种非常有效的艾滋病毒预防工具，但妇女并未广泛使用。女性