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

亲属关系：同伴导航员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: 9926752
• 负责人: Emily F Dauria
• 金额: $ 16.13万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 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 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926752
• 关键词: AIDS prevention; AIDS/HIV problem; Address; Adherence; African American; Age; Alcohol or Other Drugs use; Awareness; Belief; 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; Hispanics; Human immunodeficiency virus test; Imprisonment; Individual; Intervention; Intervention Studies; Interview; Justice; Knowledge; Learning; Link; Medical; Mental Health; Minority Groups; Modeling; Newly Diagnosed; Participant; Patients; Population; Prevention; Prevention strategy; Preventive Intervention; Preventive healthcare; Process; Provider; Public Health; Randomized; Recording of previous events; 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; United States; United States National Institutes of Health; Woman; Women' s Group; Work; barrier to care; base; behavior change; behavioral health; care systems; clinical care; control trial; design; effective intervention; efficacy testing; ethnic identity; ethnic minority population; experience; follow-up; health care availability; health care service; health disparity; high risk; improved; injection drug use; innovation; interest; intersectionality; intervention effect; 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; 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.

项目概要/摘要 耻辱仍然是影响艾滋病毒风险的主要因素。参与刑事司法系统的妇女 复杂且高度污名化的性和药物使用风险状况，特别容易受到和 经验丰富，艾滋病感染率高。暴露前预防（PrEP）是一种有效的艾滋病毒预防策略， 然而，在美国，艾滋病毒感染高危女性基本上没有参与国家努力 提高 PrEP 意识和采用率。刑事司法环境是解决问题的重要机会 通过将经历多重交叉耻辱的高危女性与创新技术联系起来，消除艾滋病毒方面的差异 HIV 生物医学预防策略，如 PrEP。同行主导的患者导航干预措施已证明 建立信任并减少与医疗保健参与相关的耻辱和歧视障碍的功效，以及 具有解决多重、交叉的耻辱和其他多因素和复杂障碍的巨大潜力 PrEP 对涉及女性的刑事司法的可接受性、联系和采用。作为一个多学科团队 艾滋病毒临床医学和护理级联研究、交叉性、耻辱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）对涉及司法的人群的干预措施，我们建议 为有艾滋病毒感染风险的女性开发并测试同行主导的患者导航 PrEP 联动干预措施 他们在旧金山处于缓刑期。干预措施的开发和研究设计将由我们的指导 团队的试点研究、耻辱和艾滋病毒差异框架以及 PrEP 连续护理模型。 研究目的是： 1) 确定同行主导的 PrEP 筛选和链接导航的内容和结构 针对高风险 CJI 女性的干预（KINSHIP 项目）； 2) 细化和测试内容和结构 对涉及妇女的刑事司法的亲属关系干预； 3) 评估可行性、可接受性和 试点中亲属关系干预对内在耻辱和 PrEP 连续护理的初步影响 随机试验。与主要利益相关者（包括缓刑妇女、缓刑人员）开展形成性定性工作 目标 1 中的工作人员和医疗/公共卫生人员将指导目标 2 中的干预措施开发和测试。在目标 3 中， 我们将检查 PrEP 服务链接的主要结果和次要结果，例如链接时间、 PrEP 处方/启动，以及 PrEP 坚持/坚持。我们将探讨交叉耻辱如何可能 对 PrEP 关联的中等干预效果。拟议的研究有可能：1）减少影响 交叉耻辱作为服务护理参与的障碍，2) 告知 PrEP 护理连续体估计 参与刑事司法的妇女并找出障碍，3) 制定适合大规模的干预措施 功效测试并转化为其他刑事司法环境。