A Multi-Level Trauma-Informed Approach to Increase HIV Pre-exposure Prophylaxis Initiation among Black Women

一种多层次的创伤知情方法，以增加黑人女性中艾滋病毒暴露前预防的启动

• 批准号: 10817423
• 负责人: Tiara C. Willie
• 金额: $ 108.77万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-21 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10817423
• 关键词: AIDS prevention; Address; Adoption; Affect; Baltimore; Black race; Caring; Client; Clinic; Clinical; Collaborations; Community Healthcare; Consolidated Framework for Implementation Research; Data; Data Aggregation; Disparity population; Education; Educational Materials; Effectiveness; Eligibility Determination; Environment; Ethnic Population; Evaluation; Exposure to; Face; Gender; Geography; HIV; HIV Infections; HIV disparities; Health system; Healthcare; Healthcare Systems; Hybrids; Infection; Intervention; Interview; Knowledge; Learning; Mediator; Medical; Mississippi; Modeling; Monitor; Neighborhood Health Center; Outcome; Policies; Prevention strategy; Process; Protocols documentation; Provider; Public Health; Race; Randomized; Research; Sampling; Self Efficacy; Sexism; Social support; Stereotyping; Structure; Support Groups; Surveys; System; Training; Trauma; Woman; arm; black women; cis-female; community setting; design; effectiveness evaluation; effectiveness testing; effectiveness/implementation study; epidemic preparedness; epidemiologic data; experience; health care availability; health disparity populations; high risk; implementation evaluation; implementation outcomes; implementation strategy; implementation study; improved; innovation; insight; intersectionality; intervention cost; intimate partner violence; novel; patient-clinician communication; peer; peer support; post implementation; pre-exposure prophylaxis; prevent; racial disparity; racial population; racism; screening; social structure; structural determinants; theories; therapy design; traumatic event; treatment arm; two-arm trial; uptake

Project Summary Black cisgender women (hereafter, Black women) carry a disproportionate HIV burden than women in other racial and ethnic groups. Despite its promise, there is an unmet need for pre-exposure prophylaxis (PrEP) among Black women. Intimate partner violence (IPV) and gendered racism may exacerbate racial disparities in PrEP access and also curb potential real-world effectiveness. IPV reduces PrEP uptake among women. Black women also experience unfair treatment due to deeply ingrained stereotypes by healthcare systems. As such, Black women may feel uncomfortable discussing PrEP with a provider or provider biases may prevent PrEP access. Integrating trauma-informed care into community health centers that serve Black women may enhance PrEP adoption. Trauma-informed care can help providers understand IPV, medical mistrust and gendered racism within the context of Black women’s experiences. System policies can also be modified to be trauma-informed for both staff and Black women clients. In addition to changing health systems, peer navigation could be a successful model of care to improve PrEP engagement. Peer navigation can build self-efficacy in patient-provider communication and decrease medical mistrust offsetting the impact of socio-structural barriers. The proposed research aims to address this gap via the implementation and evaluation of a trauma-informed multilevel intervention designed to increase PrEP initiation among Black women. This intervention includes a trauma- informed PrEP Implementation Toolkit for staff in community healthcare clinics in addition to a trauma-informed peer navigation model. We propose a hybrid type 2 effectiveness-implementation study with clinical staff, peer navigators, and clients. Aim 1 includes adapting an existing trauma-informed peer navigation for PrEP-eligible Black women. Qualitative data from semi-structured interviews with 20 Black women clients will be used to adapt the peer navigation. Aim 2 includes assessing the effectiveness of the trauma-informed multilevel intervention. The toolkit will be employed in clinics using a stepped wedge design with monthly aggregated clinic data collected 8 months before and after toolkit implementation in each clinic. Toolkit effectiveness will be assessed using within- and between-clinic changes in PrEP initiation. Staff will complete baseline, immediate post, and 3-month post surveys to assess mechanisms of change. In a parallel two-arm trial, 300 Black women clients will be randomized to receive either peer navigation (intervention arm) or support group only (control arm) and will complete baseline, 1-, 3-, and 6- month post-randomization surveys. The primary client outcomes will be 1-, 3-, and 6-month PrEP initiation. Aim 3 includes assessing the implementation of the multilevel intervention. Adoption, acceptability, appropriateness, and sustainability will be assessed with 3-month post-toolkit staff surveys; and at 1-, 3-, and 6- month client post-randomization surveys. Intervention costs will be computed using an ingredients-based approach. Fidelity will be assessed with the fidelity-monitoring approach for multilevel trials.

项目摘要 黑色的顺性妇女（以下称为黑人妇女）携带不成比例的艾滋病毒伯恩（Hiv Burnen） 种族和种族。尽管有承诺，但仍未满足预防前的预防（PREP） 黑人妇女。亲密的伴侣暴力（IPV）和性别种族主义可能加剧种族分布 访问以及遏制潜在的现实世界有效性。 IPV减少了女性的准备吸收。黑人妇女 由于医疗保健系统的深刻诱导刻板印象，还会经历不公平的待遇。因此，黑色 妇女可能会感到不舒服与提供者或提供商的偏见讨论准备，这可能会阻止PREP访问。 将创伤信息的护理整合到服务黑人妇女的社区卫生中心可能会增强准备 采用。创伤信息的护理可以帮助提供者了解IPV，医疗不信任和性别种族主义 在黑人妇女的经历中。系统策略也可以修改为受创伤的信息 对于员工和黑人女性客户。除了改变卫生系统外，同行导航可能是 成功的护理模型，以改善准备工作。同行导航可以在患者提供者中建立自我效能感 沟通和减少医疗不信任抵消社会结构障碍的影响。提议 研究旨在通过实施和评估创伤信息多级的实施和评估来解决这一差距 干预旨在增加黑人妇女的准备计划。这种干预包括创伤 除了受创伤的信息外 同行导航模型。我们提出了一项与临床人员，同伴的Hybrid 2型有效性研究研究 导航员和客户。 AIM 1包括适应现有的创伤信息同行导航以合格的 黑人妇女。来自20个黑人女性客户的半结构化访谈的定性数据将用于适应 同行导航。 AIM 2包括评估创伤性多层次干预的有效性。 该工具包将使用阶梯楔设计在诊所中使用，并每月收集的临床数据 在每个诊所的工具包实施前8个月。工具包有效性将使用 准备计划的临床内和临床之间的变化。员工将完成基线，立即邮政和3个月 调查后评估变化机制。在一项平行的两臂试验中，将有300位黑人女性客户 随机接收同行导航（干预组）或仅支持组（控制臂），将 全面的基线，1-，3和6个月后，随机化调查。主要客户结果将为1-，3-， 和6个月的准备计划。 AIM 3包括评估多层次干预的实施。 将与3个月后员工一起评估采用，可接受性，适当性和可持续性 调查；并在1，3个月和6个月的客户后随机化调查。干预费用将使用 基于成分的方法。忠诚度将通过用于多级试验的忠实监测方法来评估。