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

艾滋病毒和亲密伴侣暴力是相互交叉、相互强化的流行病， 黑人女性，尤其是在美国南部。IPV加剧了艾滋病毒的异性传播。IPV暴露 妇女感染艾滋病毒的可能性是其同行的四倍。暴露于IPV的女性在 与艾滋病毒感染者发生强迫和胁迫性行为、无安全套性行为、长期 对安全性行为（避孕套）谈判和使用药物的恐惧。男性IPV犯罪者更有可能 未经治疗的艾滋病毒，直接增加妇女的艾滋病毒风险。为了应对美国艾滋病毒和IPV的交叉， 2020年国家艾滋病毒/艾滋病战略呼吁采取措施，“扩大公共宣传，教育， 艾滋病毒和其他交叉问题的预防工作，如IPV。终止艾滋病毒流行（EHE）计划 进一步强调需要在艾滋病毒高负担地区加强艾滋病毒预防， 有机会增加IPV暴露的黑人妇女对独立于伴侣的艾滋病毒预防的接受， 这些地区暴露前预防（PrEP）是一种用户控制的有效的IPV艾滋病毒预防策略， 暴露的黑人妇女，但国家数据表明，PrEP是严重不足的妇女相比， 男人疾病预防控制中心概述了为妇女实施PrEP的两个挑战：（1）妇女的准确性 评估其个人和伴侣的艾滋病毒风险;（2）很少有设置提供PrEP介绍。知情 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， PrEP意识，重新调整个人风险估计，并赋予妇女权力，使她们能够在知情的情况下， 决策家庭暴力（DV）机构的PrEP决策援助可以解决这些PrEP实施问题 挑战我们的II型混合有效性-实施研究旨在适应现有的PrEP决策辅助 在马里兰州的巴尔的摩寻求家庭暴力服务的暴露于IPV的黑人妇女，这是EHE的优先领域。自我和 将实施PrEP决策辅助的倡导者管理版本，并将使用 一项由实施研究综合框架（CFIR）指导的双臂随机试验。一 使用与IPV暴露的黑人妇女（N=20）和家庭暴力倡导者的定性访谈进行的形成性评价 （N=10），以适应现有的PrEP决策辅助。下一步，决策辅助将在 一个DV机构和60名IPV暴露的黑人妇女将被随机分配到自我管理或倡导者管理组。 不同版本的援助，以比较可行性，可接受性和初步有效性在PrEP吸收与 基线、1个月、3个月和6个月调查。与家庭暴力倡导者的焦点小组将评估执行进程 成果。这项研究将：为解决艾滋病毒预防的关键问题的PrEP决策援助提供支持 暴露于IPV的黑人妇女人口;使用实施科学来增加地理区域的PrEP吸收 马里兰州巴尔的摩的优先地区;将家庭暴力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，为扩大PrEP提供信息。

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.