The HIV epidemic among women in the United States (US) is a major public health issue and Black and Hispanic women disproportionately affected. Many women at high risk for acquiring HIV infection are not aware of an effective HIV prevention option. An oral antiretroviral medication is now available by prescription for pre- exposure prophylaxis (PrEP). Oral PrEP is an efficacious, self-administered, woman-controlled, HIV prevention product. There is a wide gap between recommended use of this effective biomedical HIV prevention method and actual care for women at high risk for acquiring HIV - a gap that needs to be closed in order to avoid worsening already glaring HIV health disparities among women in the US. Alarmingly, there are currently no interventions in the US to promote PrEP uptake among women. The long term goal is to develop effective approaches to support PrEP use and reduce HIV acquisition among high risk women and thereby reduce HIV health disparities. We propose that a theory-based, contextually relevant behavioral intervention combined with linkage to health care and social services, with text message support for adherence, would be feasible and acceptable and could improve PrEP uptake among high risk women. The objective of this study is to develop and evaluate an intervention to promote PrEP uptake. Since varying HIV prevention public policy landscapes may also be a factor influencing PrEP uptake, this study will be conducted in two large metropolitan areas with local HIV rates that greatly exceed the national average but with different PrEP public policy and access landscapes.
The aims are to : 1.Conduct formative research (40 in-depth interviews and 102 surveys) to identify the association of social-cognitive characteristics, including pre-disposing (e.g., PrEP knowledge, attitudes, norms, self-efficacy and beliefs), enabling (e.g., perceived access to care) and need (perceived HIV risk, risk compensation) with intention of PrEP uptake (initiate, adhere) and assess how these factors are influenced by relevant background factors (e.g., socio-demographics, resources, vulnerability factors). 2. Use findings from Aim 1 to develop an individually-tailored intervention for women to promote PrEP uptake behaviors (initiate, adhere), connect to local PrEP providers, link to community resources that address personal and social barriers to PrEP uptake, and provide a text-message reminder system to support PrEP adherence. 3. To evaluate the feasibility and acceptability of the intervention in a pilot trial (n= 80). The secondary outcomes are to: a) examine PrEP uptake intention & behavior; b) evaluate satisfaction in accessing health care for PrEP, comparing the two sites, and in using a text-message reminder system to support PrEP adherence. Our novel approach combines proven health promotion strategies, linkage to care and technology for substantive impact. This research will advance our understanding of bio-behavioral HIV prevention strategies in heavily affected communities within different PrEP policy and access landscapes. .
This proposed research is relevant to public health because it will improve understanding of the factors that affect uptake of currently underutilized but potentially life-saving services and offers an intervention to close the gap between optimal and typical care. The project is relevant to the NIH Plan for HIV-Related Research because it will develop and evaluate a novel targeted theory-based intervention, which promotes salient individual factors and access to needed services to address racial, ethnic, and socioeconomic disparities in HIV acquisition.
