Yale University

Optimizing PrEP's Potential in Non-Clinical Settings: Development and Evaluation of a PrEP Shared Decision Making Tool for Women Seeking Domestic Violence Services

Funder: National Institute of Mental Health
Project period: 11/15/2019 - 11/14/2020
Grant Type: Research

Abstract Text:

Women who experience intimate partner violence (IPV) are four-times more likely to be infected with HIV compared to their counterparts. IPV-exposed women are at greater risk for HIV infection due to forced and coerced sex by a coercive and forced sex with partners with HIV, condomless sex, enduring fear of safe sex (condom) negotiations, and substance use. Male perpetrators of IPV are more likely to have untreated HIV and engage in risky sexual behaviors, directly increasing women's HIV risk. In response to this intersection of HIV and IPV among U.S. women, the 2020 National HIV/AIDS Strategy called for initiatives that "expanded public outreach, education, and prevention efforts on HIV and other intersecting issues such as IPV." Research efforts are needed to increase uptake of partner-independent HIV prevention among IPV-exposed women. Preexposure prophylaxis (PrEP) is a user-controlled, potentially effective HIV prevention strategy for IPV-exposed women. However, national data indicates that PrEP is severely underutilized by women compared to men. The CDC outlined two key challenges to PrEP implementation for U.S. women: (1) women's ability to accurately assess their personal and partners' HIV risk; and (2) few settings offer introductions to PrEP. 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. Specifically, a PrEP shared decision aid located in domestic violence (DV) agencies could address these key PrEP implementation challenges. Therefore, our Type II hybrid effectiveness-implementation study seeks to adapt an existing PrEP decision aid to IPV-exposed women seeking DV services at 2 agencies. Given the dearth of research on decision aids in this population, a self- and advocate-administered version of the PrEP decision aid will be implemented in separate sites and the aid will be evaluated using a quasi-experimental design. The Consolidated Framework for Implementation Research (CFIR) will guide the formative and implementation evaluations. First, a formative evaluation using qualitative interviews with IPV-exposed women (N=20) and DV advocates (N=10) will be conducted to adapt the existing PrEP decision aid to IPV-exposed women and DV agencies. Next, the decision aid will be implemented in 2 DV agencies (one per site) and compared in terms of feasibility, acceptability, and preliminary effectiveness with surveys among IPV-exposed women (N=40; 20 per agency) and focus groups with DV advocates. This study will: provide support for a PrEP decision aid that addresses the HIV prevention needs of IPV-exposed women; use implementation science to increase PrEP uptake; include DV agencies in intervention development and implementation; and improve understanding of PrEP scale-up by addressing implementation factors in the community settings that serve IPV-exposed women.