She's PrEPared: The Impact of Intimate Partner Violence on Women's Engagement in the PrEP Care Continuum

她已做好准备：亲密伴侣暴力对女性参与 PrEP 护理连续体的影响

• 批准号: 9410681
• 负责人: Tiara C. Willie
• 金额: $ 4.4万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9410681
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; Affect; Caring; Cognition; Cohort Studies; Communication; Complex; Continuity of Patient Care; Data; Data Analyses; Dependence; Depressed mood; Development; Economics; Eligibility Determination; Epidemic; Epidemiologist; Face; Federal Aid; Feeling; Fellowship; Forcible intercourse; Freedom; Funding; Future; HIV; HIV Infections; HIV Seropositivity; HIV risk; Incidence; Income; Insurance; Interview; Life; Linear Regressions; Link; Machine Learning; Mediator of activation protein; Medical; Mental Depression; Mental Health; Mentors; Methods; Modeling; Occupations; Oral; Pathway interactions; Pharmaceutical Preparations; Preventive Intervention; Process; Qualitative Methods; Reporting; Research; Research Design; Research Priority; Research Training; Resources; Risk Factors; Role; Safe Sex; Sexual Health; Social Sciences; Statistical Data Interpretation; Substance abuse problem; Testing; Time; Training Programs; United States National Institutes of Health; Violence; Visit; Woman; Women' s Health; Work; career; daily functioning; depressive symptoms; design; experience; fight against; follow-up; improved; insight; interest; intimate partner violence; medication compliance; novel; pre-exposure prophylaxis; prevent; skills; therapy development; uptake

Project Summary/Abstract A significant relationship exists between intimate partner violence (IPV) and HIV. IPV-exposed women are almost 10 times more likely to report an HIV infection. Extant research indicates multiple direct (e.g., forced sex with risky partner) and indirect (e.g., poor mental health) pathways linking IPV experiences to HIV risk. Developing ways to prevent HIV among IPV-exposed women that is not partner-dependent is needed. Pre- exposure prophylaxis (PrEP), is a daily oral medication and may be the most viable and novel HIV prevention option for IPV-exposed women. However, engaging in PrEP care can be hard including multiple steps (e.g., daily adherence, quarterly medical visits). Women's engagement in the PrEP care continuum may be disrupted by four HIV-related risk factors (economic instability, sexual autonomy, substance abuse, depressive symptoms). First, economic instability can make women dependent on their abusive partner for money and insurance, which may hinder PrEP uptake and adherence. Second, women with low sexual autonomy (e.g., freedom to express one's sexual self) may feel unable or uncomfortable using PrEP if her partner disagree with her wish to use PrEP, which can prevent PrEP uptake. Lastly, substance abuse and feelings of depression can disrupt cognition, making it difficult to engage in daily functions, which may prevent PrEP adherence. To date, there is a dearth of studies examining the implications of IPV on women's engagement in the PrEP care continuum, despite the potential barriers associated with IPV. This is concerning since the Trans-NIH HIV- Related Research Priorities called for research addressing how violence influences experiences along the HIV prevention continuum. This F31 aims to improve the sexual health of women across these research aims: (1a) Examine the effects of IPV on women's engagement in the PrEP care continuum (i.e., interest, uptake, adherence, follow-up visits), and HIV-related risk factors using data from a cohort study of women (n=250); (1b) Explore four HIV-related risk factors as mediators linking IPV and the PrEP care continuum; and (2) Describe women's experiences and processes along the PrEP care continuum (n=32). The proposed research addresses a critical need to understand the relationship between IPV and women's engagement in the PrEP care continuum in order to implement PrEP care in a safe and effective way. This research will devise PrEP engagement strategies, inform intervention development, and help the fight against HIV/AIDS for women. During this 2-year research and training fellowship, the applicant will develop interdisciplinary social science skills including advancing statistical analysis skills, gaining experience in mixed-methods study design and qualitative data analysis, while refining academic and scientific communication. This comprehensive training program will prepare the applicant for a career as an independent violence epidemiologist and academic mentor conducting empirical IPV research while designing HIV prevention interventions with for women.

项目摘要/摘要 亲密伴侣暴力（IPV）和艾滋病毒之间存在着重要的关系。暴露于IPV的妇女是 报告艾滋病毒感染的可能性近10倍。现有的研究表明多个直接（例如，强制性 具有风险的伴侣）和间接（例如，心理健康差）将IPV体验与艾滋病毒风险联系起来。 需要开发不依赖伴侣的IPV暴露女性中预防艾滋病毒的方法。 pre 预防暴露（PREP）是每天的口服药物，可能是最可行和新颖的HIV预防 暴露于IPV的女性的选择。但是，从事准备工作可能很难包括多个步骤（例如， 每日依从性，季度医疗访问）。妇女参与预科护理连续体的参与可能会受到干扰 由四个与HIV相关的危险因素（经济不稳定，性自治，滥用药物，抑郁症 症状）。首先，经济不稳定可以使妇女依赖虐待伴侣的钱， 保险，这可能会阻碍吸收和依从性。其次，性自主性低的妇女（例如 如果她的伴侣不同意，则表达自己的性自我的自由可能会感到无法或不舒服 她希望使用准备，这可以防止预备摄取。最后，药物滥用和抑郁症的感觉可以 破坏认知，使每日功能很难，这可能会阻止准备依从性。迄今为止， 缺乏研究IPV对女性参与预备护理的影响的研究 连续体，尽管与IPV相关的潜在障碍。这是关于跨性别的NIH HIV- 相关研究的优先事项要求研究解决暴力如何影响艾滋病毒的经历 预防连续体。该F31旨在改善这些研究的妇女的性健康目的：（1a） 检查IPV对妇女参与预科护理连续体的影响（即兴趣，吸收， 使用妇女队列研究中的数据（n = 250）的数据，依从性，随访访问）和与HIV相关的风险因素； （1B）探索四个与HIV相关的危险因素，因为将IPV和PREP CARE连续体连接起来； （2） 描述女性沿预期连续体的经历和过程（n = 32）。拟议的研究 解决了了解IPV与妇女参与Prep之间的关系的迫切需求 护理连续体，以安全有效的方式实施预备护理。这项研究将设计准备 参与策略，为干预开发提供信息，并帮助抗击妇女的艾滋病毒/艾滋病。 在这项为期两年的研究和培训奖学金中，申请人将发展跨学科的社会科学 技能，包括提高统计分析技能，获得混合方法研究设计的经验和 定性数据分析，同时完善学术和科学沟通。这种全面的培训 计划将为申请人做准备职业生涯的独立暴力流行病学家和学术 在设计女性预防艾滋病毒预防干预措施时，进行经验IPV研究的导师。