Linkage to Community-Based HIV Pre-Exposure Prophylaxsis Care Among at Risk Women upon Release from Incarceration

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Incarcerated women engage in high rates of sex- and drug-related behavior that place them at risk for HIV. Pre-exposure prophylaxis (PrEP) is an efficacious means of reducing HIV acquisition. There is a general lack of knowledge regarding PrEP among women at elevated risk, and only a small percentage of at-risk women are currently engaged in PrEP care. The period of incarceration represents an opportunity to identify at-risk women, initiate PrEP during incarceration, and establish linkage to community-based PrEP care upon release from incarceration. Further, post-release is a time period that is particularly risky, and there are numerous barriers that may impede linkage to community-based care in the absence of intervention. To date, very little research has been done to improve linkage to PrEP care among US women. The proposed study will examine the acceptability, feasibility, and preliminary efficacy of a psychoeducation and motivational interviewing intervention to promote PrEP initiation during incarceration, followed by a patient navigator intervention to facilitate linkage to community-based PrEP care upon release from incarceration. The long-term goal of this line of research is to disseminate an efficacious PrEP Care linkage intervention for at-risk women post- release from incarceration. The present proposal seeks to develop intervention materials and conduct a small randomized controlled trial (RCT) of the intervention. In Phase 1 of the proposed study, we will conduct individual interviews (IDIs) with at-risk incarcerated women (n=18-30) and with stakeholders at the correctional facility (n=6-10) and the community-based PrEP care site (n=6-10). Phase 2 will consist of a pilot phase in which at-risk, incarcerated women (n=8-12) receive the intervention and provide feedback regarding the intervention. Phase 3 (n=80) will consist of a preliminary RCT comparing the intervention to a control condition that approximates standard-of-care (SOC). RCT participants will complete a baseline interview and follow-up interviews at 1, 3, and 6 months. The primary outcome will be linkage to community-based care, verified via medical records. We expect that, as a result of this project, we will have determined the feasibility, acceptability, and preliminary efficacy of our proposed intervention. If found to be efficacious, this intervention has the potential to reduce HIV acquisition in a high-need, underserved community.