Development and pilot testing of a mobile health application to improve HIV prevention and substance use treatment service access among women involved in the carceral system

项目摘要 与内脏系统有关的女性更有可能感染艾滋病毒、药物使用障碍和 服药过量的人比社区的同龄人更多。暴露前预防(PrEP)已成为一种 强大的艾滋病毒预防工具，与阿片类药物使用障碍(Moud)相结合，可以 严重影响艾滋病毒和过量用药的风险。患者导航具有解决多因素问题的强大潜力 参与治疗的妇女在PrEP和物质使用、治疗、联系和吸收方面的复杂障碍 监禁系统。与患者导航相结合，eHealth具有改善医疗保健的潜力 这群女性的订婚。作为一个在艾滋病毒预防方面拥有专业知识的多学科团队 实施科学研究、技术增强、注重性别问题和注重行为健康 (药物使用、心理健康和艾滋病毒预防)个人干预和干预发展 涉及到监禁系统，我们建议检查使用基于技术的 作为现有导航计划的附件，为离开监狱的妇女改善与PrEP和Moud的联系 费城(宾夕法尼亚州)的设置。干预开发和研究设计将由我们团队的飞行员和 正在进行的研究，以及EPIS实施框架。研究的目的是：1)评估女性参与 内脏系统对PrEP和Moud的感知以及启动和坚持的潜在障碍；2) 开发PA-Links基于网络的应用程序并评估可用性和可接受性；以及3)试点干预措施以 评估在参与PrEP和Moud的内脏系统中的妇女的有效性的前景 将PA链接集成到现有的患者导航中。一项对参与监禁系统的妇女的调查 AIM 1将使用感知映射分析来指导AIM中的原型应用程序开发和用户测试 2.在目标3中，我们将研究PrEP和Moud服务联系的主要结果和次要结果 例如PrEP和Moud处方/启动、PrEP和Moud坚持/持久性、感知和 干预的知识和可接受性。社区咨询委员会将向各方面通报 建议的研究。这项试点研究将通过以下方式对艾滋病毒和药物滥用治疗领域作出重大贡献 研究在附属机构中使用基于技术的、量身定做的性别敏感干预措施的潜在影响 现有的导航系统位于市区的社区医疗中心。研究结果将提供至关重要的 为随后的R01提案提供的信息，以严格评估急需的艾滋病毒预防 专门为满足高危妇女独特的文化和社会需要而制定的干预措施。

Project Summary Women involved with the carceral system are more at risk of HIV infection, substance use disorders, and overdose than their community-based counterparts. Pre-exposure prophylaxis (PrEP) has emerged as a powerful HIV-prevention tool and in combination with Medication for Opioid Use Disorder (MOUD) could significantly impact HIV and overdose risk. Patient navigation holds strong potential to address multifactorial and complex barriers to PrEP and substance use treatment linkage and uptake for women involved in the carceral system. In tandem with patient navigation, eHealth has the potential to improve healthcare engagement for this group of women. As a multidisciplinary team with expertise in HIV-prevention implementation science research, technology enhanced, gender-responsive, and behavioral health focused (substance use, mental health and HIV prevention) interventions, and intervention development for individuals involved in the carceral system, we propose to examine the potential impact of using a technology-based adjunct to an existing navigation program to improve linkage to PrEP and MOUD for women leaving carceral settings in Philadelphia (PA). Intervention development and study design will be guided by our team’s pilot and on-going research, and the EPIS Implementation Framework. Study aims are to: 1) Assess women involved in the carceral systems’ perceptions of PrEP and MOUD and potential barriers to initiation and adherence; 2) Develop the PA-Links web-based app and assess usability and acceptability; and 3) Pilot the intervention to assess for promise of efficacy in engaging women involved in the carceral systems in PrEP and MOUD by integrating PA-Links into existing patient navigation. A survey of women involved in the carceral system and perceptual mapping analyses will be used in Aim 1 to guide proto-type app development and user testing in Aim 2. In Aim 3, we will examine the primary outcome of PrEP and MOUD service linkage and secondary outcomes such as PrEP and MOUD prescription/initiation, PrEP and MOUD adherence/persistence, perceptions and knowledge, and acceptability of the intervention. A Community Advisory Board will inform all aspects of the proposed study. This pilot study will significantly contribute to the field of HIV and substance abuse treatment by examining the potential impact of using technology based, tailored, gender-responsive interventions in adjunct with existing navigation in an urban, community-based health center. Study results will provide crucial information for a subsequent R01 proposal to rigorously evaluate an urgently needed HIV prevention intervention developed specifically to meet the unique cultural and social needs of high-risk women.