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

基本信息

批准号：
10654773
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
项目类别：
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/10654773
关键词：
AIDS prevention Address Adoption Advocate Affect Area Awareness Baltimore Black race Characteristics Clinical Clinical Trials Design 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 Eligibility Determination Epidemic Evaluation Event Exclusion Focus Groups Forcible intercourse Fright Gender Geography HIV HIV Infections HIV risk HIV/AIDS 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 Report (document)Research Risk Risk Assessment Risk Estimate Safe Sex Safety Service setting Services Structure Surveys Testing Trauma Unsafe Sex Violence Woman arm black women cis-female combat condoms effectiveness/implementation study empowerment epidemic preparedness evidence base experience formative assessment implementation barriers implementation context implementation determinants implementation evaluation 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 randomized, clinical trials response risk perception scale up service providers sex social stigma substance use therapy development tool transmission process uptake violence exposure

项目摘要

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) 是相互交叉、相辅相成的流行病，严重影响黑人女性，尤其是美国南部的黑人女性，会加剧 IPV 的异性传播。女性感染艾滋病毒的可能性是接触 IPV 的女性的四倍。由于强迫和胁迫与感染艾滋病毒的伴侣发生性行为、无安全套性行为、持久性行为，感染艾滋病毒的风险更大男性 IPV 犯罪者更有可能对安全性行为（安全套）谈判和药物使用产生恐惧。未经治疗的艾滋病毒，直接增加了女性感染艾滋病毒的风险。针对女性，2020 年国家艾滋病毒/艾滋病战略呼吁采取举措“扩大公共宣传、教育和艾滋病毒和 IPV 等其他交叉问题的预防工作。” 终止艾滋病毒流行 (EHE) 计划进一步强调需要在艾滋病毒负担高的地区加强艾滋病毒预防，并且有增加接触 IPV 的黑人妇女接受独立于伴侣的艾滋病毒预防的机会这些领域中，暴露前预防 (PrEP) 是一种由用户控制的有效 HIV 预防策略。接触过的黑人女性，但国家数据表明，与女性相比，女性对 PrEP 的利用严重不足 CDC 概述了女性实施 PrEP 面临的两个挑战：(1) 女性的准确度。评估其个人和伴侣的艾滋病毒风险；(2) 很少有机构提供 PrEP 介绍。决策辅助可以克服这些障碍，因为它们是以患者为中心的干预措施，可以增加 PrEP 意识，重新调整个人风险评估，并赋权女性做出明智的、基于价值观的决策家庭暴力 (DV) 机构的 PrEP 决策援助可以解决这些 PrEP 的实施问题。我们的 II 类混合有效性实施研究旨在调整现有的 PrEP 决策辅助工具。向在马里兰州巴尔的摩寻求 DV 服务的暴露于 IPV 的黑人妇女提供服务，该地区是 EHE 优先区域。将实施 PrEP 决策援助的倡导者管理版本，并将使用以下方式评估该援助一项以实施研究综合框架 (CFIR) 为指导的双臂随机试验。通过对接触 IPV 的黑人女性 (N=20) 和家庭暴力倡导者进行定性访谈进行形成性评估 (N=10) 将进行现有 PrEP 决策援助的调整接下来，决策援助将在实施。 DV 机构和 60 名接触过 IPV 的黑人女性将被随机分配到自我管理组或倡导者管理组比较 PrEP 实施的可行性、可接受性和初步有效性的援助版本与家庭暴力倡导者一起进行的基线、1、3 和 6 个月调查将评估实施过程。本研究将：为 PrEP 决策援助提供支持，以解决艾滋病毒预防的关键问题。暴露于 IPV 的黑人女性群体；利用实施科学来提高该地区的 PrEP 接受率马里兰州巴尔的摩的优先领域；将家庭暴力机构纳入干预措施的制定和实施；通过解决为暴露于 IPV 的黑人女性提供服务的环境中的实施因素，为 PrEP 的扩大提供信息。