PrEP Uptake among Justice Involved Peripregnancy Women Who Use Drugs

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PROJECT SUMMARY This is a proposal to identify an intervention strategy and develop an implementation strategy to increase pre- exposure prophylaxis (PrEP) and HIV prevention services for peripregnancy criminally-justice (CJ)-involved women who use drugs (WWUD) in the Greater Miami area. Peripregnancy CJ-involved WWUD constitute a population of particular importance to ending the HIV epidemic (EHE) because so many CJ-involved women are structurally marginalized, live in poverty, and are often forced to move between low-wage care/service work and sex work for economic survival, placing them at high risk for HIV. Additionally, women’s pathway to incarceration is characterized by criminalizing behaviors associated with gender-based violence, including drug use and sex work, and therefore infectious disease risk. Nearly 4% of CJ-involved women are estimated to be pregnant, and nearly 15% of all pregnant women in the U.S. meet criteria for substance use disorder, with WWUD during pregnancy facing heightened HIV vulnerability. Accordingly, women have become the fastest- growing segment of the incarcerated population, with rates climbing at double that of men. PrEP for HIV is highly effective for preventing HIV and is indicated among pregnant WWUD to prevent HIV acquisition. One goal for the EHE initiative is to increase the percentage of prescriptions among PrEP-eligible individuals to 50% by 2025. Thus, there is an urgent need for research on barriers and facilitators to implementing the HIV PrEP care continuum for this “multiply disadvantaged” health population. Our leadership team includes researchers from the University of Miami and service providers, including formerly incarcerated women, from Ladies Empowerment & Action Program (LEAP), a Miami-based nonprofit organization focused on women’s reentry. Our study is guided by the Consolidated Framework for Implementation Research and proposes to conduct qualitative interviews and brief surveys with stakeholders and peripregnancy CJ-involved WWUD (“patients”). The specific aims are to: (1) Engage stakeholders to assess, both quantitatively and qualitatively, their attitudes towards PrEP, perceived acceptability, appropriateness, and feasibility of different PrEP intervention strategies, and how inner setting (implementation climate, organizational networks, organizational commitment) and outer setting (local external policies) factors may hinder or facilitate intervention implementation. (2) Identify qualitatively the multilevel barriers and facilitators to HIV prevention from the perspective of peripregnancy CJ-involved WWUD and assess through mixed-methods the perceived potential effectiveness, including acceptability and appropriateness, of different PrEP intervention strategies. Knowledge gained from this study will have a significant public health impact by informing HIV risk prevention strategies, and barriers and facilitators to HIV prevention and PrEP uptake among peripregnancy CJ-involved WWUD. Our long-term goal is to develop an equity-focused approach to HIV prevention and advance reproductive justice and wellbeing for structurally marginalized women.