HIV and intimate partner violence (IPV) are intersecting, mutually-reinforcing epidemics that significantly affect African American women, particularly women in the U.S. South. African American women face some of the highest rates of both HIV and IPV among U.S. women, and these burdens are most pronounced in the South. IPV-exposed African American women may experience forced, condomless sex, which increases the risk of HIV acquisition. Pre-exposure prophylaxis (PrEP) is the most innovative HIV prevention strategy, however it remains underutilized by African American women and residents of the South. In order to reduce African American women?s HIV acquisition risk in the South, effective HIV prevention interventions need to concurrently address relationship safety and HIV acquisition risks. The proposed training plan in this Mentored Research Scientist Development Award (K01) application will provide the knowledge and skills that the principal investigator, Tiara C. Willie, PhD, MA needs to launch an independent and productive research career. Further, the proposed research would contribute significantly to PrEP implementation in real-world settings and facilitate PrEP access to African American women in the South. The proposed research aims to address this call via the development, testing, and evaluation of a PrEP Implementation Toolkit for staff in community healthcare clinics in the South. The Toolkit will be evaluated using the Reach, Effectiveness- Adoption, Implementation, Maintenance (RE-AIM). The Toolkit will facilitate PrEP uptake among eligible African American women in the South, especially IPV-exposed women. This K01 project includes formative work (i.e., reach stage), like key informant interviews with staff at partnering clinics (N=10), and six focus groups with African American women. The qualitative data will inform the development of the PrEP Implementation Toolkit. The Toolkit will be employed in two clinics using a nonrandomized waitlist control design. Monthly aggregated clinic data will be collected 8-months before and after Toolkit implementation in each clinic. Toolkit effectiveness will be assessed using interrupted time series analyses and outcomes are changes in PrEP uptake, coverage and retention among African American women. Four focus groups with staff will be conducted to assess adoption, acceptability, and feasibility. 20 qualitative interviews with staff will be conducted to assess fidelity. This project will yield preliminary evidence of a PrEP implementation program for African American women with a focus on IPV. It will also inform future large-scale studies using stepped- wedge designs. The training acquired by Dr. Willie via this timely and novel project, courses, workshops, conferences, manuscript and grant-writing, and mentorship will target 3 training objectives to gain expertise in: (1) HIV prevention research among African American women, (2) intervention development and evaluation, and (3) implementation science in clinics.
Pre-exposure prophylaxis (PrEP) may be a viable option for African American women at-risk for HIV infection, but few studies have identified optimal strategies to reach African American women in need of PrEP nor examined effective strategies to scale-up PrEP among African American women in the South. African American women in the South experience high rates of intimate partner violence (IPV) which could force women to choose between HIV prevention or IPV prevention. The proposed research study seeks to develop, pilot-test, and evaluate a PrEP Implementation Toolkit within two community healthcare clinics located in Jackson, Mississippi to increase PrEP uptake among African American, address IPV as a barrier to PrEP uptake, and ultimately combat racial disparities in women?s HIV diagnoses.
