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

项目摘要 参与监狱系统的妇女更容易感染艾滋病毒，物质使用障碍， 比他们的社区同行过量。暴露前预防（PrEP）已经成为一种 一个强大的艾滋病毒预防工具，并与阿片类药物使用障碍（MOUD）相结合， 严重影响艾滋病毒和过量风险。患者导航具有解决多因素 和复杂的障碍，以准备和物质使用治疗的联系和吸收的妇女参与 监狱系统与患者导航相结合，电子健康有可能改善医疗保健 为这群女性服务。作为一个具有艾滋病毒预防专门知识的多学科小组， 实施科学研究，加强技术，促进性别平等，注重行为健康 （药物使用、心理健康和艾滋病毒预防）干预措施，以及针对个人的干预措施发展 参与监狱系统，我们建议研究使用基于技术的 作为现有导航计划的补充，以改善与PrEP和MOUD的联系，使女性离开监狱 Philadelphia（PA）干预开发和研究设计将由我们团队的试点和 正在进行的研究，以及EPIS实施框架。研究的目的是：（1）评估妇女参与 监狱系统对PrEP和MOUD的看法以及启动和遵守的潜在障碍; 2） 开发PA-Links网络应用程序，并评估可用性和可接受性;以及3）试点干预措施， 评估参与PrEP和MOUD的宫颈系统的妇女的有效性承诺， 将PA链接集成到现有的患者导航中。对参与监狱系统的妇女的调查， 感知映射分析将用于目标1，以指导原型应用程序开发和目标中的用户测试 2.在目标3中，我们将检查PrEP和MOUD服务联系的主要结果和次要结果 如PrEP和MOUD处方/启动、PrEP和MOUD依从性/持续性、感知和 知识和干预的可接受性。一个社区咨询委员会将告知各方面的 建议的研究。这项试点研究将通过以下方式对艾滋病毒和药物滥用治疗领域作出重大贡献： 审查在联合国系统内使用基于技术、量身定制、对性别问题敏感的干预措施的潜在影响， 与现有的导航在一个城市，社区为基础的健康中心。研究结果将提供关键的 为随后的R01提案提供信息，以严格评估迫切需要的艾滋病毒预防措施 专门为满足高危妇女独特的文化和社会需求而制定的干预措施。

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.