Development and Evaluation of a PrEP Decision Aid for Women Seeking Domestic Violence Services in Baltimore

针对巴尔的摩寻求家庭暴力服务的妇女的 PrEP 决策援助的开发和评估

• 批准号: 10468296
• 负责人: Jaimie Meyer
• 金额: $ 24.71万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-11 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10468296
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adoption; Advocate; Affect; Area; Awareness; Baltimore; Black race; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Clinical Trials Design; Coercion; Cognitive; Collaborations; Communities; Connecticut; Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Decision Aid; Development; Disclosure; Disinhibition; Domestic Partners; Domestic Violence; Education; Effectiveness; Epidemic; Evaluation; Event; Focus Groups; Forcible intercourse; Fright; Gender; Geography; HIV; HIV Infections; HIV risk; Heterosexuals; Individual; Intervention; Interview; Link; Maryland; Mediation; Modification; Needs Assessment; Outcome; Pharmacotherapy; Population; Prevention; Prevention Research; Prevention program; Prevention strategy; Process; Provider; Public Health; Randomized; Randomized Clinical Trials; Reporting; Research; Risk; Risk Assessment; Safe Sex; Safety; Service setting; Services; Structure; Surveys; Testing; Time; Trauma; Unsafe Sex; Violence; Woman; arm; base; black women; cis-female; combat; condoms; effectiveness implementation study; empowered; evidence base; experience; formative assessment; implementation barriers; implementation context; implementation determinants; implementation evaluation; implementation outcomes; implementation process; implementation science; improved; innovation; interest; intimate partner violence; male; men; novel; outreach; patient oriented; perpetrators; pre-exposure prophylaxis; preference; preventive intervention; racial disparity; randomized trial; response; risk perception; scale up; service providers; sex; social stigma; substance use; therapy development; tool; transmission process; uptake; violence exposure

HIV and intimate partner violence (IPV) are intersecting, mutually-reinforcing epidemics that significantly affect Black women, particularly in the U.S. South. IPV escalates heterosexual transmission of HIV. IPV-exposed women are four-times more likely to be infected with HIV than their counterparts. IPV-exposed women are at greater risk for HIV infection due to forced and coerced sex with partners with HIV, condomless sex, enduring fear of safe sex (condom) negotiations and substance use. Male IPV perpetrators are more likely to have untreated HIV, directly increasing women’s HIV risk. In response to the intersection of HIV and IPV among U.S. women, the 2020 National HIV/AIDS Strategy calls for initiatives that “expand public outreach, education, and prevention efforts on HIV and other intersecting issues such as IPV.” The Ending the HIV Epidemic (EHE) Plan further emphasizes the need to increase HIV prevention in areas with high HIV burden, and there is an opportunity to increase uptake of partner-independent HIV prevention among IPV-exposed Black women in these areas. Pre-exposure prophylaxis (PrEP) is a user-controlled, effective HIV prevention strategy for IPV- exposed Black women, but national data indicates that PrEP is severely underutilized by women compared to men. The CDC has outlined two challenges to PrEP implementation for women: (1) women’s accurate assessment of their personal and partners’ HIV risk; and (2) few settings offer PrEP introductions. Informed decision aids can overcome these obstacles because they are patient-centered interventions that can increase PrEP awareness, reorient personal risk estimation, and empower women to make informed, values-based decisions. A PrEP decision aid in domestic violence (DV) agencies could address these PrEP implementation challenges. Our Type II hybrid effectiveness-implementation study seeks to adapt an existing PrEP decision aid to IPV-exposed Black women seeking DV services in Baltimore, Maryland, an EHE priority area. Self- and advocate-administered versions of the PrEP decision aid will be implemented and the aid will be evaluated using a two-arm randomized trial, guided by the Consolidated Framework for Implementation Research (CFIR). A formative evaluation using qualitative interviews with IPV-exposed Black women (N=20) and DV advocates (N=10) will be conducted to adapt the existing PrEP decision aid. Next, the decision aid will be implemented in a DV agency and 60 IPV-exposed Black women will be randomized to either the self- or advocate-administered versions of the aid to compare feasibility, acceptability and preliminary effectiveness at PrEP uptake with baseline, 1-, 3-, and 6-month surveys. Focus groups with DV advocates will assess for implementation process outcomes. This study will: provide support for a PrEP decision aid that addresses HIV prevention for the key population of IPV-exposed Black women; use implementation science to increase PrEP uptake in the geographic priority area of Baltimore, Maryland; include DV agencies in intervention development and implementation; and inform PrEP scale-up by addressing implementation factors in settings that serve IPV-exposed Black women.

艾滋病毒和亲密伴侣暴力（IPV）是相交的，相互强化的流行病，显着影响 黑人妇女，特别是在美国南部。 IPV升级HIV的异性传播。 IPV暴露 妇女感染艾滋病毒的可能性要比其同行高四倍。暴露于IPV的妇女在 由于与艾滋病毒，无避孕套性行为，持久的伴侣强迫性和强迫性别引起的艾滋病毒感染风险更大 害怕安全性（避孕套）谈判和物质使用。男性IPV肇事者更有可能拥有 未经治疗的艾滋病毒，直接增加了妇女的艾滋病毒风险。为了应对美国的艾滋病毒和IPV的交集 妇女，2020年的国家艾滋病毒/艾滋病战略呼吁采取行动，以“扩大公共外展，教育和 预防艾滋病毒和其他相交问题（例如IPV）的努力。 进一步强调需要增加艾滋病毒负担高的地区的艾滋病毒预防，并且有一个 在IPV暴露的黑人妇女中，有机会增加对伴侣独立的HIV预防摄取的机会 这些区域。暴露前预防（PREP）是用户控制的，有效的IPV- 暴露于黑人妇女，但国家数据表明，与 男人。疾病预防控制中心概述了为妇女做准备的两个挑战：（1）女性的准确性 评估其个人和伴侣的艾滋病毒风险； （2）很少有设置提供准备介绍。通知 决策辅助工具可以克服这些障碍，因为它们是以患者为中心的干预措施，可以增加 准备意识，重新定向个人风险估算，并授权妇女使知情，基于价值观 决定。对家庭暴力（DV）机构的预先决策援助可以解决这些预备实施 挑战。我们的II型混合有效性实施研究旨在调整现有的预先决策援助 向IPV暴露的黑人妇女寻求在马里兰州巴尔的摩的DV服务，这是优先区。自我和 将实施倡导者的预定版本，并将使用 由合并实施研究框架（CFIR）指导的两臂随机试验。一个 使用对IPV暴露的黑人妇女（n = 20）和DV倡导者进行定性访谈的形成性评估 （n = 10）将进行调整现有的预先决策援助。接下来，将在 DV机构和60个IPV暴露的黑人妇女将被随机分配给自我或倡导者的管理 援助的版本以比较可行性，可接受性和初步效果 基线，1-，3-和6个月的调查。具有DV倡导者的焦点小组将评估实施过程 结果。这项研究将：为预防预防艾滋病毒预防的预先决策援助提供支持 暴露于IPV的黑人妇女的人口；使用实施科学来增加地理的准备 马里兰州巴尔的摩的优先区；在干预开发和实施中包括DV机构；和 通过解决为IPV暴露的黑人妇女服务的设置中的实施因素，告知准备规模。