PrEP Uptake among Justice Involved Peripregnancy Women Who Use Drugs

项目总结 这是一项建议，旨在确定干预战略并制定实施战略，以增加 预防暴露(PrEP)和孕期艾滋病毒预防服务--刑事司法(CJ)--涉及 在大迈阿密地区使用毒品的妇女(WWUD)。围孕期CJ受累的WWUD构成 对结束艾滋病毒流行(EHE)特别重要的人群，因为有如此多的CJ妇女参与其中 在结构上被边缘化，生活在贫困中，经常被迫在低工资的护理/服务之间流动 工作和性工作是为了经济生存，这使他们面临感染艾滋病毒的高风险。此外，女性通往 监禁的特点是将与基于性别的暴力有关的行为定为犯罪，包括毒品。 使用和性工作，因此有传染病的风险。据估计，近4%的CJ涉案女性 怀孕，美国近15%的孕妇符合物质使用障碍的标准， WWUD在怀孕期间面临更高的艾滋病毒易感性。因此，女性成为最快的-- 被监禁人口的比例越来越高，比例是男性的两倍。为艾滋病毒做准备的是 对预防艾滋病毒非常有效，并在怀孕的WWUD中用于预防艾滋病毒感染。一 EHE倡议的目标是将符合PrEP条件的个人的处方比例提高到 到2025年达到50%。因此，迫切需要研究实施艾滋病毒的障碍和促进者。 为这一“倍增弱势”的健康人群提供连续的准备护理。我们的领导团队包括 来自迈阿密大学和服务提供商的研究人员，包括以前被监禁的女性，来自 妇女赋权和行动计划(LEAP)，一个总部设在迈阿密的非营利性组织，专注于妇女的 重返大气层。我们的研究以实施研究综合框架为指导，并建议 与利益相关者和孕期CJ参与的WWUD进行定性访谈和简短调查 (“病人”)。具体目标是：(1)促使利益攸关方在数量和质量上进行评估， 他们对PrEP的态度、不同PrEP的可接受性、适宜性和可行性 干预策略，以及内部环境(实施环境、组织网络、组织 承诺)和外部环境(地方外部政策)因素可能阻碍或促进干预 实施。(2)定性地确定预防艾滋病毒的多层次障碍和促进者 围孕期CJ受累WWUD的远景分析及综合评估 不同PrEP干预策略的有效性，包括可接受性和适当性。知识 从这项研究中获得的信息将对公共卫生产生重大影响，因为它将为艾滋病毒风险预防战略提供信息， 和障碍和促进者的艾滋病毒预防和PrEP感染围孕期CJ-参与WWUD。 我们的长期目标是开发一种注重公平的方法来预防艾滋病毒并促进生殖 结构边缘化妇女的正义和福祉。

PROJECT SUMMARY This is a proposal to identify an intervention strategy and develop an implementation strategy to increase pre- exposure prophylaxis (PrEP) and HIV prevention services for peripregnancy criminally-justice (CJ)-involved women who use drugs (WWUD) in the Greater Miami area. Peripregnancy CJ-involved WWUD constitute a population of particular importance to ending the HIV epidemic (EHE) because so many CJ-involved women are structurally marginalized, live in poverty, and are often forced to move between low-wage care/service work and sex work for economic survival, placing them at high risk for HIV. Additionally, women’s pathway to incarceration is characterized by criminalizing behaviors associated with gender-based violence, including drug use and sex work, and therefore infectious disease risk. Nearly 4% of CJ-involved women are estimated to be pregnant, and nearly 15% of all pregnant women in the U.S. meet criteria for substance use disorder, with WWUD during pregnancy facing heightened HIV vulnerability. Accordingly, women have become the fastest- growing segment of the incarcerated population, with rates climbing at double that of men. PrEP for HIV is highly effective for preventing HIV and is indicated among pregnant WWUD to prevent HIV acquisition. One goal for the EHE initiative is to increase the percentage of prescriptions among PrEP-eligible individuals to 50% by 2025. Thus, there is an urgent need for research on barriers and facilitators to implementing the HIV PrEP care continuum for this “multiply disadvantaged” health population. Our leadership team includes researchers from the University of Miami and service providers, including formerly incarcerated women, from Ladies Empowerment & Action Program (LEAP), a Miami-based nonprofit organization focused on women’s reentry. Our study is guided by the Consolidated Framework for Implementation Research and proposes to conduct qualitative interviews and brief surveys with stakeholders and peripregnancy CJ-involved WWUD (“patients”). The specific aims are to: (1) Engage stakeholders to assess, both quantitatively and qualitatively, their attitudes towards PrEP, perceived acceptability, appropriateness, and feasibility of different PrEP intervention strategies, and how inner setting (implementation climate, organizational networks, organizational commitment) and outer setting (local external policies) factors may hinder or facilitate intervention implementation. (2) Identify qualitatively the multilevel barriers and facilitators to HIV prevention from the perspective of peripregnancy CJ-involved WWUD and assess through mixed-methods the perceived potential effectiveness, including acceptability and appropriateness, of different PrEP intervention strategies. Knowledge gained from this study will have a significant public health impact by informing HIV risk prevention strategies, and barriers and facilitators to HIV prevention and PrEP uptake among peripregnancy CJ-involved WWUD. Our long-term goal is to develop an equity-focused approach to HIV prevention and advance reproductive justice and wellbeing for structurally marginalized women.