Optimizing PrEP Utilization among Alcohol and Other Drug (AOD) Using Women of Color

项目摘要 本管理补充文件(PA-18-591)响应NOT-AA-20-011，利用现有的NIAAA U34 新冠肺炎相关社会环境应激源对患者影响的时效性研究 在为受艾滋病毒影响最严重的少数民族女性提供艾滋病毒连续护理方面的经验 南佛罗里达州的人口，现在是新大流行的震中之一。突发公共卫生事件引发 新冠肺炎在日常生活、社会结构和就业方面造成了前所未有的破坏，因为 为了减缓疾病的传播，已经强制执行了社交疏远的缓解命令。新出现的证据 表明新型冠状病毒的最严重后果和缓解措施将落在 美国少数民族人口历来承受着健康差距的负担。家长研究《优化PrEP》 使用有色人种妇女在酒精和其他药物(AOD)中的利用(U34AA026219)是第一个这样的项目 致力于改善非裔美国人、拉丁裔和海地妇女实施和接受PrEP的情况 在南佛罗里达州的艾滋病毒热点地区，并产生了一种以社区为基础的参与式驱动的可复制模式 研究(CBPR)。在新冠肺炎之前，这些研究人群的经济资源有限，健康状况普遍 不平等和据报告的亲密伴侣暴力行为水平很高。大流行可能产生的有害影响 尚未对南方有色人种妇女或艾滋病毒卫生保健提供者进行调查或报告 为他们服务的。补充资料将利用纵向、混合的方法，在母研究的 社会生态框架，以填补有关大流行对护理参与的影响的关键知识空白 以及坚持PrEP和酒精和药物使用、精神健康和其他辅助护理的支持性服务 在三个关键的少数民族人口中，妇女。我们的具体目标包括：1)远程评估体验 AOD使用、护理投入、PrEP服药依从性和HIV风险因素的抽样调查 目前在父母研究中登记的艾滋病毒风险肤色，比较采取的措施 新冠肺炎前，(T1)到COVID后评估，(T2和T3)，相隔3个月；2)通过互联网测量 调查卫生服务提供和社会距离因大流行而发生的变化 在一组健康护理人员中感受到的护理质量、患者信任和提供者压力 参与了家长研究的社区动员阶段；以及3)远程进行半结构化 采访来自AIM 1的部分女性和来自AIM 2的健康提供者，以探索与CoVID相关的问题 在护理方面的经验、需求、需要改进的领域，以及吸引和留住使用AOD的妇女的战略 艾滋病毒连续护理体系。拟议目标的方法和实施将在 家长研究的CBPR框架，并将为抵消大流行的不利应激源和 保护在这些人群中预防艾滋病毒方面取得的成果。

Project Summary This administrative supplement (PA-18-591) in response to NOT-AA-20-011, leverages an existing NIAAA U34 study for time-sensitive research on the impact of social environmental stressors related to COVID-19 on patient and provider experience in the HIV continuum of care for the most HIV-affected ethnic minority female populations in S. Florida, now in one of the epicenters of the new pandemic. The public health emergency posed by COVID-19 has caused unprecedented disruption in daily living, social structures, and employment as mitigation mandates of social distancing have been enforced to slow the spread of illness. Emerging evidence suggests that the most severe consequences from the novel coronavirus and the mitigation efforts will fall upon U.S. ethnic minority populations historically burdened by health disparities. The parent study, “Optimizing PrEP Utilization among Alcohol and Other Drug (AOD) Using Women of Color” (U34AA026219), is the first such project devoted to improving implementation and uptake of PrEP among African American, LatinX and Haitian women in the HIV hotspots of S. Florida and has produced a replicable model driven by community-based participatory research (CBPR). Before COVID-19, these study populations had limited economic resources, prevalent health disparities and reported high levels of intimate partner violence. The possible deleterious effects of the pandemic have not yet been investigated or reported for women of color in the South or for the HIV health care providers that serve them. The supplement will utilize longitudinal, mixed methods data collection within the parent study’s social ecological framework to fill critical knowledge gaps about the pandemic’s impact on engagement in care and adherence to PrEP and supportive services for alcohol and drug use, mental health, and other ancillary care in the three key ethnic minority populations of women. Our specific aims include: 1) remotely assess experiences in AOD use, engagement in care, PrEP medication adherence, and HIV risk factors among a sample of women of color at risk for HIV who are currently enrolled participants in the parent study, comparing measures taken pre-COVID-19, (T1), to post-COVID assessments, (T2 and T3), taken 3 months apart; 2) measure via internet surveys changes in health services delivery and social distancing due to the pandemic on access to and perceived quality of care, patient trust, and provider stress among a group of health care workers who participated in the community mobilization phase of the parent study; and 3) remotely conduct semi-structured interviews with a subset of women from Aim 1 and health providers from Aim 2 to explore COVID-related experiences, needs, areas for improvement in care, and strategies to engage and retain AOD-using women in the HIV continuum of care. The methods and implementation of the proposed aims will be fulfilled within the parent study’s CBPR framework and will inform efforts to offset the adverse stressors of the pandemic and preserve gains that have been made in HIV prevention in these populations.