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）是一种高效的艾滋病毒预防工具，但女性并未广泛使用。女性 在美国南部，艾滋病毒占年度艾滋病毒诊断的 55%，暴力和创伤始终存在联系 这些女性的艾滋病毒风险增加。长期目标是建立一种新的治疗提供模式 将生物医学艾滋病毒预防服务纳入精神卫生保健机构，从而消除个人和提供者- 为患有创伤相关疾病且因问题而面临艾滋病毒风险的妇女提供 PrEP 护理的障碍 物质使用或危险的性行为。总体目标是 (i) 阐明个人和提供商层面的障碍 PrEP 的采用和坚持，并在信息-动机-行为技能 (IMB) 模型的指导下，(ii) 建立一个 基于心理健康诊所的行为干预，以提高该人群的 PrEP 吸收率和依从性。这 中心假设是，与标准治疗相比，心理健康治疗中提供的干预措施 整合知识、行为技能以及参与和坚持 PrEP 护理的动机的环境将导致 服用第一份 PrEP 处方的参与者比例更高。在第一年，我们将进行 1A 阶段研究 确定开发综合治疗时需要解决的关键问题。从接受过治疗的女性那里获得的访谈数据 针对创伤相关病症的心理健康治疗及其治疗提供者将用于最终确定治疗方案的设计 比较标准治疗与综合治疗（心理健康治疗和艾滋病毒预防）的试点试验（第 1B 阶段） 干涉。新的综合干预措施将包括以 IMB 模型为指导的动机咨询，该模型寻求 通过信息共享、增加改变动机以及教授行为技能来影响行为改变 提高自我效能。为了验证假设，将追求以下具体目标：（1）收集有关 有关 PrEP 使用的知识和态度，并获得有关综合行为的潜在设计的反馈 接受创伤相关疾病治疗且有感染艾滋病毒风险的妇女及其妇女的干预；和（2） 制定综合行为干预措施，以促进正在接受治疗的女性对 PrEP 的吸收和依从性 患有创伤相关疾病的艾滋病毒高危人群； (3) 评估方案的可行性、可接受性和初步效果 干涉。申请人认为，本申请中提出的研究具有创新性，因为心理健康 治疗环境地理位置优越，可以为 HIV 预防提供额外的服务，包括 PrEP，但是，对我们来说 知识方面，尚未对将 PrEP 服务全面纳入女性心理健康治疗进行评估。这 研究意义重大，因为它有望为持续发展提供科学依据 针对经历过创伤的妇女的独特需求量身定制的行为干预措施。最终，这样的研究 可以为制定创新战略提供信息，以提高有效艾滋病毒预防战略的采用。