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

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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.