Project kINSHIP: Peer navigators addressing INtersectional Stigma to improve HIV Prevention among criminal-justice involved women

亲属关系项目：同伴导航者解决跨部门耻辱问题，以改善涉及刑事司法的妇女的艾滋病毒预防

• 批准号: 10538195
• 负责人: Emily F Dauria
• 金额: $ 27.72万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538195
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; African American; Age; Awareness; Belief; Black race; Caring; Case Management; Clinical Medicine; Communities; Complex; Continuity of Patient Care; Criminal Justice; Data; Development; Discrimination; Epidemic; Face; Feedback; Focus Groups; Future; General Population; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV risk; Health system; High Risk Woman; Hispanic; Human immunodeficiency virus test; Imprisonment; Individual; Intervention; Intervention Studies; Interview; Justice; Knowledge; Latinx; Learning; Link; Medical; Mental Health; Minority Women; Modeling; Newly Diagnosed; Participant; Patients; Population; Prevention; Prevention strategy; Preventive healthcare; Process; Provider; Public Health; Randomized Controlled Trials; Recording of previous events; Reduce health disparities; Reporting; Research; Research Design; Research Priority; Risk; Risk Behaviors; San Francisco; Services; Sex Behavior; Sexual Partners; Shapes; Stigmatization; Structure; System; Testing; Time; Training; Translations; Trauma; Trust; Underserved Population; United States; United States National Institutes of Health; Woman; Women' s Group; Work; acceptability and feasibility; barrier to care; base; behavior change; behavioral health; care systems; clinical care; design; effective intervention; efficacy testing; ethnic identity; ethnic minority; ethnic minority population; experience; follow-up; health care availability; health care service; health disparity; high risk; improved; injection drug use; innovation; interest; internalized stigma; intersectionality; intervention effect; marginalized population; medication compliance; multidisciplinary; navigator intervention; novel; peer; pilot trial; pre-exposure prophylaxis; prevention service; primary outcome; probation; programs; racial and ethnic; racial minority; randomized trial; screening; secondary outcome; sex; social stigma; standard of care; substance use; therapy development; trial comparing; uptake

Project Summary/Abstract Stigma persists as a principle factor shaping HIV risk. Women involved in the criminal justice system have complex and highly stigmatized sexual and substance use risk profiles and are particularly vulnerable to, and experience, high rates of HIV. Pre-exposure prophylaxis, or PrEP, is an efficacious HIV prevention strategy, however, women at high-risk of HIV infection in the United States (US) are largely absent from national efforts to improve PrEP awareness and uptake. Criminal justice settings represent an important opportunity to address disparities in HIV by linking high-risk women, who experience multiple, intersecting stigmas with innovative biomedical HIV prevention strategies, like PrEP. Peer-led patient navigation interventions have demonstrated efficacy in building trust and reducing stigma and discrimination-related barriers to healthcare engagement, and hold strong potential to address multiple, intersecting stigmas and other multifactorial and complex barriers to PrEP acceptability, linkage, and uptake for criminal justice involved women. As a multidisciplinary team with expertise in HIV clinical medicine and care cascade research, intersectionality, stigma, and behavioral health (substance use, mental health and HIV prevention) interventions for justice-involved populations, we propose to develop and test a peer-led patient navigator PrEP linkage intervention for women at risk for HIV acquisition who are on probation in San Francisco. Intervention development and study design will be guided by our team's pilot research, the Stigma and HIV Disparities Framework, and the PrEP Continuum of Care model. Study aims are to: 1) Determine the content and structure of a peer-led PrEP screening and linkage navigation intervention (Project kINSHIP) for high-risk CJI-women; 2) Refine and test the content and structure of the kINSHIP intervention for criminal justice involved women; and 3) Assess the feasibility, acceptability, and preliminary impact of the kINSHIP intervention on internalized stigma and the PrEP continuum of care in a pilot randomized trial. Formative qualitative work with key stakeholders, including women on probation, probation staff, and medical/public health staff in Aim 1 will guide intervention development and testing in Aim 2. In Aim 3, we will examine the primary outcome of PrEP service linkage and secondary outcomes such as time to linkage, PrEP prescription/initiation, and PrEP adherence/persistence. We will explore how intersectional stigma may moderate intervention effects on linkage to PrEP. The proposed study has the potential to: 1) reduce the impact of intersectional stigma as a barrier to service care engagement, 2) inform PrEP care continuum estimates for criminal justice-involved women as well as identify barriers, and 3) create an intervention suitable for large-scale efficacy testing and translation to other criminal justice settings.

项目摘要/摘要 污名仍然是塑造艾滋病毒风险的主要因素。参与刑事司法系统的妇女有 复杂且高度污名化的性和物质使用风险特征，特别容易受到影响，并且 经验，艾滋病毒率高。暴露前预防或PREP是一种有效的HIV预防策略， 但是，美国（美国）的艾滋病毒高风险妇女在很大程度上没有国家努力 提高准备意识和吸收。刑事司法环境代表着解决的重要机会 通过联系高风险妇女的艾滋病毒差异 生物医学艾滋病毒预防策略，例如准备。同伴领导的患者导航干预措施已证明 建立信任和减少污名和与医疗保健参与的歧视障碍以及 具有强大的潜力，可以解决多个相交的污名和其他多因素和复杂障碍 准备可接受性，联系和刑事司法涉及妇女。作为一个多学科团队 HIV临床医学和护理级联研究，交叉性，污名和行为健康方面的专业知识 （药物使用，心理健康和艾滋病毒预防）对诉讼官员的干预措施，我们建议 开发和测试由同伴领导的患者导航员准备连锁干预妇女的艾滋病毒危险风险 在旧金山进行缓刑的人。干预开发和研究设计将由我们的指导 团队的试点研究，污名和艾滋病毒差异框架以及护理模型的准备连续性。 研究目的是：1）确定由同行主导的预备筛选和连锁导航的内容和结构 高危CJI-WOMEN的干预（项目亲属关系）； 2）完善并测试 刑事司法的亲属干预涉及妇女； 3）评估可行性，可接受性和 亲属干预对内部化污名和飞行员的预期护理的初步影响 随机试验。与关键利益相关者的形成性定性工作，包括缓刑妇女 AIM 1的员工和医疗/公共卫生人员将指导AIM 2中的干预开发和测试。在AIM 3中， 我们将研究准备服务联系的主要结果和次要结果，例如链接的时间， 准备处方/启动，以及准备依从性/持久性。我们将探讨交叉污名如何 中等干预对与准备联系的影响。拟议的研究有可能：1）减少影响 交叉污名作为服务护理参与的障碍，2）信息预期预计 犯罪司法妇女以及识别障碍，3）创建适合大规模的干预措施 功效测试和转化为其他刑事司法机构。

项目成果

"Good luck, social distance": rapid decarceration and community care for serious mental illness and substance use disorder during the COVID-19 pandemic.

• DOI: 10.1186/s40352-023-00238-5
• 发表时间: 2023-09-18
• 期刊: HEALTH & JUSTICE
• 影响因子: 3.5
• 作者: James, Jennifer E.;Dauria, Emily F.;Desai, Riya;Bell, Adelaide;Izenberg, Jacob M.
• 通讯作者: Izenberg, Jacob M.