A Multi-Level Trauma-Informed Approach to Increase HIV Pre-exposure Prophylaxis Initiation among Black Women

项目摘要 黑人顺性别妇女（以下简称黑人妇女）的艾滋病毒负担比其他种族的妇女不成比例。 种族和民族群体。尽管它的承诺，有一个未满足的需要，暴露前预防（PrEP）， 黑人女性亲密伴侣暴力（IPV）和性别种族主义可能会加剧PrEP中的种族差异 并抑制潜在的现实世界的有效性。IPV减少了妇女对PrEP的吸收。黑人女性 由于医疗保健系统根深蒂固的陈规定型观念，他们也受到不公平的待遇。因此，Black 女性可能会感到不舒服，与提供者讨论PrEP或提供者偏见可能会阻止PrEP访问。 将创伤知情护理整合到为黑人妇女服务的社区卫生中心可以增强PrEP 领养创伤知情护理可以帮助提供者了解IPV，医疗不信任和性别种族主义 在黑人女性的经历中。系统策略也可以修改为创伤通知 为工作人员和黑人妇女客户。除了改变卫生系统，同行导航可能是一个 成功的护理模式，以改善PrEP参与。同伴导航可以建立医患双方的自我效能感 沟通和减少医疗不信任，抵消社会结构障碍的影响。拟议 研究的目的是通过实施和评估创伤知情的多层次， 旨在增加黑人妇女PrEP启动的干预措施。干预包括创伤- 知情的PrEP实施工具包的工作人员在社区医疗诊所除了创伤知情 同伴导航模型我们提出了一个混合型2有效性实施研究与临床工作人员，同行 导航员和客户。目标1包括调整现有的创伤知情同行导航，以适应符合PrEP条件的 黑人女性从20名黑人妇女客户的半结构化访谈的定性数据将被用来适应 同行导航。目标2包括评估创伤知情多层次干预的有效性。 该工具包将在诊所使用，采用阶梯式楔形设计，每月收集汇总诊所数据 在每个诊所实施工具包前后8个月。工具包的有效性将使用 PrEP启动的诊所内和诊所间变化。工作人员将完成基线、即时员额和3个月 进行调查，以评估变革机制。在一个平行的两组试验中，300名黑人女性客户将被 随机接受同伴导航（干预组）或仅支持组（对照组），并将 完成基线、随机化后1个月、3个月和6个月调查。主要的客户结果将是1-，3-， 和6个月的PrEP启动。目标3包括评估多层面干预措施的执行情况。 采用、可接受性、适当性和可持续性将由工具包后3个月的工作人员进行评估 调查;以及随机化后1个月、3个月和6个月的客户调查。干预成本将使用 一种基于成分的方法。将采用多水平试验的保真度监测方法评估保真度。

Project Summary Black cisgender women (hereafter, Black women) carry a disproportionate HIV burden than women in other racial and ethnic groups. Despite its promise, there is an unmet need for pre-exposure prophylaxis (PrEP) among Black women. Intimate partner violence (IPV) and gendered racism may exacerbate racial disparities in PrEP access and also curb potential real-world effectiveness. IPV reduces PrEP uptake among women. Black women also experience unfair treatment due to deeply ingrained stereotypes by healthcare systems. As such, Black women may feel uncomfortable discussing PrEP with a provider or provider biases may prevent PrEP access. Integrating trauma-informed care into community health centers that serve Black women may enhance PrEP adoption. Trauma-informed care can help providers understand IPV, medical mistrust and gendered racism within the context of Black women’s experiences. System policies can also be modified to be trauma-informed for both staff and Black women clients. In addition to changing health systems, peer navigation could be a successful model of care to improve PrEP engagement. Peer navigation can build self-efficacy in patient-provider communication and decrease medical mistrust offsetting the impact of socio-structural barriers. The proposed research aims to address this gap via the implementation and evaluation of a trauma-informed multilevel intervention designed to increase PrEP initiation among Black women. This intervention includes a trauma- informed PrEP Implementation Toolkit for staff in community healthcare clinics in addition to a trauma-informed peer navigation model. We propose a hybrid type 2 effectiveness-implementation study with clinical staff, peer navigators, and clients. Aim 1 includes adapting an existing trauma-informed peer navigation for PrEP-eligible Black women. Qualitative data from semi-structured interviews with 20 Black women clients will be used to adapt the peer navigation. Aim 2 includes assessing the effectiveness of the trauma-informed multilevel intervention. The toolkit will be employed in clinics using a stepped wedge design with monthly aggregated clinic data collected 8 months before and after toolkit implementation in each clinic. Toolkit effectiveness will be assessed using within- and between-clinic changes in PrEP initiation. Staff will complete baseline, immediate post, and 3-month post surveys to assess mechanisms of change. In a parallel two-arm trial, 300 Black women clients will be randomized to receive either peer navigation (intervention arm) or support group only (control arm) and will complete baseline, 1-, 3-, and 6- month post-randomization surveys. The primary client outcomes will be 1-, 3-, and 6-month PrEP initiation. Aim 3 includes assessing the implementation of the multilevel intervention. Adoption, acceptability, appropriateness, and sustainability will be assessed with 3-month post-toolkit staff surveys; and at 1-, 3-, and 6- month client post-randomization surveys. Intervention costs will be computed using an ingredients-based approach. Fidelity will be assessed with the fidelity-monitoring approach for multilevel trials.