Addressing Health Disparities in Engagement, Retention, and Utilization of PrEP Among South Florida Women of Color

Study Overview
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Brief Summary
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Women of color (WOC) in South Florida, the region with the highest HIV rates in the U.S., experience significant barriers to accessibility, uptake, and utilization of Pre-exposure prophylaxis (PrEP) for HIV prevention, despite FDA approval since 2012. The purpose of this study is to use a Community-Based Participatory Research (CBPR) approach to finalize, and pilot-test a multi-component evidence-based intervention to reduce health disparities in engagement, utilization, and retention in PrEP care, with the goal of improving HIV prevention outcomes for the target population of WOC in S. Florida, primarily African American, Latina, and Haitian women in 3 designated Ending the HIV Epidemic (EHE) counties: Miami-Dade, Broward, and Palm Beach counties.

Detailed Description
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The purpose of this study is to use a Community-Based Participatory Research (CBPR) approach to finalize, and pilot-test a multi-component evidence-based intervention to reduce health disparities in engagement, utilization, and retention in PrEP care, with the goal of improving HIV prevention outcomes for the target population of WOC in S. Florida. We will conduct an exploratory pilot of the PrEP intervention, using a quasi-experimental design, among 80 multi-ethnic WOC in Miami-Dade, Broward, and Palm Beach counties to evaluate feasibility, acceptability, and fidelity. PrEP uptake, adherence, and retention in care will be measured over a 4-month period, including biomarkers of adherence. Adult women initiating or returning to PrEP services at our collaborating sites will be recruited, consented, enrolled and complete baseline assessments. They will participate in an adapted Integrating ENGagement and Adherence Upon Entry (iENGAGE) intervention to address social determinants of health barriers to maintaining PrEP care.

Official Title
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Addressing Health Disparities in Engagement, Retention, and Utilization of PrEP Among South Florida Women of Color

Conditions
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HIV Prevention, PrEP Adherence

Intervention / Treatment
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* Behavioral: iENGAGE for PrEP


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: >=18 years of age; female and identifying as female gender; able to provide informed consent; willing to document a negative HIV antibody test before starting PrEP; reporting recent sexual risk (e.g., sex without condoms in last 3 months, sexually transmitted infection (STI) diagnosis in the last 6 months, post-exposure prophylaxis (PEP) use in the last 12 months, transactional sex, partners who are HIV+); report history of alcohol and other drug (AOD) use in last 3 months; willing to screen for medical contraindications to PrEP according to Florida Health Department guidelines; currently not cognitively impaired; reporting no history of bipolar disorder, psychosis, or current need for inpatient psychiatric hospitalization. Exclusion Criteria: Less than 18 years of age; not female at birth unable to provide informed consent; unwilling to document a negative HIV antibody test before starting PrEP; unwilling to screen for medical contraindications to PrEP according to Florida Health Department guidelines; currently cognitively impaired; reporting recent history of bipolar disorder, psychosis, or inpatient psychiatric hospitalization

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: iENGAGE for PrEP<br>We will conduct an exploratory pilot of the PrEP intervention, using a quasi-experimental design, among 80 multi-ethnic WOC in Miami-Dade, Broward, and Palm Beach counties to evaluate feasibility, acceptability, and fidelity. PrEP uptake, adherence, and retention in care will be measured over a 4-month period, including biomarkers of adherence. | Behavioral: iENGAGE for PrEP<br>* This intervention originally developed for people living with HIV (PLWH), is designed to promote engagement, retention, and adherence to treatment by addressing the social determinants of health that often act as barrier to remaining in care and achieving viral suppression. Based on our experience with this intervention we believe that it is well suited to similarly promote engagement, retention, and utilization of PrEP care among our proposed target population of WOC by a) removing barriers to care and b) addressing unmet needs by providing c) point-to-point linkage to care services delivered by multi-disciplinary teams of individuals within or outside of the health facility, and d) the use of telehealth visits to facilitate engagement in care and improve health visit attendance. The original iENGAGE is a 4-session, in-clinic behavioral intervention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of women | We will measure the percentage of women who, having been invited for screening, complete the screening and enroll in the study. | Baseline | 
| Monthly Change in self-reported PrEP Adherence from Baseline to 4 month follow up | In measuring adherence, we will use a self-report questionnaire to assess the of number of missed doses in the last 7 days assessed at baseline, at each monthly intervention session and at the 4 month follow-up. | Monthly through study completion, an average of 4 months | 
| Monthly Change in concentration of Tenofovir measured by urine biomarker | In measuring adherence, we will also use point of care urine testing to evaluate short-term Tenofovir concentration (for those prescribed Tenofovir) at each monthly visit to compare with self-report data. | Monthly through study completion, an average of 4 months | 
| Concentration of Tenofovir measured by dried blood spot test | In measuring adherence, we will also use dried blood spot testing for longer-term Tenofovir levels (for those prescribed Tenofovir) at the 4-month follow up assessment. | 4 month follow up | 
| Percentage of participants retained in PrEP Care | Retention in PrEP Care will be considered the percentage of women who complete the 4-month follow up assessment from those who enrolled in the study. | 4 month follow up from those enrolled in the study. |