Development and Pilot Testing of a Mental Health Clinic-Based PrEP Uptake and Adherence Intervention for Women in Treatment for Trauma-Related Conditions

暴露前预防(PrEP)是一种非常有效的艾滋病毒预防工具，但妇女并不广泛使用。女人 在美国南部，占每年艾滋病毒诊断病例的55%，暴力和创伤始终联系在一起 增加了这些女性感染艾滋病毒的风险。长期目标是建立一种新的治疗提供模式， 将生物医学艾滋病毒预防服务整合到精神卫生保健环境中，从而消除了个人和提供者- 创伤相关疾病妇女通过有问题的方式感染艾滋病毒的PrEP护理水平障碍 使用药物或危险的性行为。总体目标是(I)阐明个人和提供商层面的障碍 在信息-动机-行为技能(IMB)模型的指导下，(2)建立 以心理健康诊所为基础的行为干预，以增加该人群中PrEP的摄取和依从性。这个 中心假设是，与标准治疗相比，在心理健康治疗中提供的干预 整合知识、行为技能和参与并坚持PrEP护理的动机的环境将导致 更大比例的参与者谁填写了他们的第一个PrEP处方。在第一年，我们会进行第一阶段研究，以 确定在开发综合治疗中要解决的关键问题。从正在接受治疗的妇女那里获得的采访数据 将使用创伤相关疾病的心理健康治疗及其治疗提供者来最终确定 比较标准治疗和综合治疗(心理健康治疗和艾滋病毒预防)的试点试验(阶段1B) 干预。新的综合干预将包括由IMB模式指导的动机咨询，该模式寻求 通过信息共享、增加改变的动力和教授行为技能来影响行为改变 提高自我效能感。为了验证这一假设，将追求以下具体目标：(1)收集关于 关于PrEP使用的知识和态度，并获得关于集成行为的潜在设计的反馈 接受创伤相关疾病治疗的妇女的干预措施，她们有感染艾滋病毒和她们的风险；以及(2) 制定综合行为干预措施以促进正在接受治疗的妇女的PrEP摄取和依从性 与创伤相关的条件谁是艾滋病毒的高风险；和(3)评估可行性，可接受性和初步疗效 干预。在申请人看来，这项申请中提出的研究是创新的，因为心理健康 治疗环境处于理想位置，可以为包括PrEP在内的艾滋病毒预防提供额外服务，但对于我们的 在认识到这一点的情况下，尚未对将PrEP服务充分纳入妇女心理健康治疗的情况进行评估。这个 研究具有重要意义，因为它有望为继续发展 针对经历过创伤的女性的独特需求而量身定做的行为干预。归根结底，这种研究 可以为创新战略的制定提供信息，以提高对有效艾滋病毒预防战略的采纳。

Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool but is not widely accessed by women. Women in the southern United States account for 55% of annual HIV diagnoses, and violence and trauma are consistently linked with increased HIV risk in these women. The long-term goal is to establish a new treatment delivery model that integrates biomedical HIV prevention services into mental health care settings, thus removing individual and provider- level barriers to PrEP care for women with trauma-related conditions who are at risk for HIV through problematic substance use or risky sexual behaviors. The overall objectives are to (i) elucidate individual and provider level barriers to PrEP uptake and adherence and, guided by the Information-Motivation-Behavioral Skills (IMB) model, (ii) establish a mental health clinic-based behavioral intervention for increasing PrEP uptake and adherence in this population. The central hypothesis is that, compared to standard treatment, an intervention delivered within the mental health treatment setting that integrates knowledge, behavioral skills, and motivation to engage in and adhere to PrEP care will result in a greater proportion of participants who fill their first PrEP prescription. In Year 1, we will conduct Stage 1A research to identify key issues to address in developing the integrated treatment. Interview data obtained from women undergoing mental health treatment for trauma-related conditions and their treatment providers will be used to finalize the design of the pilot trial (Stage 1B) comparing standard treatment to the integrated (mental health treatment and HIV prevention) intervention. The new integrated intervention will include motivational counseling guided by the IMB Model which seeks to influence behavior change via information sharing, increasing motivation for change, and teaching behavioral skills to increase self-efficacy. To test the hypothesis, the following specific aims will be pursued: (1) Collect information on knowledge and attitudes about PrEP use and obtain feedback about the potential design of the integrated behavioral intervention from women undergoing treatment for trauma-related conditions who are at risk for HIV and their; and (2) Develop an integrated behavioral intervention to promote PrEP uptake and adherence in women undergoing treatment for trauma-related conditions who are at high risk for HIV; and (3) Assess feasibility, acceptability and initial efficacy of the intervention. The research proposed in this application, in the applicant’s opinion, is innovative in that the mental health treatment setting is ideally situated to provide additional services for HIV prevention including PrEP but, to our knowledge, full integration of PrEP services into mental health treatment for women has not been evaluated. The research is significant because it is expected to provide scientific justification for the continued development of behavioral interventions tailored to the unique needs of women who have experienced trauma. Ultimately, such research can inform the development of innovative strategies to improve uptake of effective HIV prevention strategies.