Pilot Mobile Medical Unit Study for I'm Fully Empowered4Her

Study Overview
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Brief Summary
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The overarching objective for the pilot study is to test the feasibility of using a mobile medical unit as a delivery mode combined with enhanced Pre-exposure Prophylaxis (PrEP) messaging to increase awareness of PrEP and access to PrEP medical services among women living in public housing.

Detailed Description
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This is a single arm feasibility study with 3-month follow-up. African American cisgender women in the South are disproportionately affected by HIV infection yet have inequitable access to Pre-exposure Prophylaxis (PrEP). To promote equitable use of PrEP by women living in low-income housing in Durham, North Carolina (NC) (the vast majority of whom are African American), the investigators aim to conduct a formative study to develop and refine a scalable PrEP delivery approach which addresses the two key barriers of access and awareness. In this pilot study the investigators will test the feasibility of the delivery mode and features of a community outreach PrEP mobile unit and provide Peer Networkers and PrEP messaging tailored to women living in public housing. The objectives of the study are to evaluate the feasibility of delivering the IFE4Her intervention in public housing communities. The IFE4Her intervention consists of: 1) a communication campaign including enhanced PrEP messaging and peer networker communication; 2) A mobile PrEP clinic. Assessments will include a satisfaction survey for participants receiving services in the mobile clinic, service records, follow-up in-depth interviews at 3 months, and chart review at 6 months to assess 3-month outcomes. Study Duration Each participant's study duration will depend upon the study activities they elect to engage in. Each subject's participation in the anonymous survey will last approximately 10 minutes immediately after their medical visit. Each subject's participation in the follow-up interview which will take place approximately 3 months after the mobile medical visit and will last approximately one hour. Medical record data (specifically follow up visit participation and prescription completion as described in detail below) will be collected after the 3 month visit but up to 6 months after participation in the initial medical visit. The entire pilot study is expected to last up to 2 years. Intervention Description Communication campaign Communication Materials - PrEP Posters and Infographics that provide information about PrEP for women, and materials on complementary health services including hypertension screening, blood glucose screening, and HIV-testing. Peer Networker Information Dissemination - Trained Peer Networkers will disseminate information about PrEP, complementary women's health issues, and the mobile medical unit through distribution of communication materials and in-person communication. Mobile Medical Unit All study-related clinical services will occur in a safe, confidential, and private space in a mobile medical unit. The mobile medical unit will offer the following services: blood pressure checks, blood glucose monitoring, rapid HIV antibody testing, and for those interested, PrEP consultation and clinical assessment and care as indicated. These services will be provided by university health care system clinicians. Participants receiving PrEP will be receive follow-up care in the university health care system. Of note, no study drug is being tested. The PrEP medication emtricitabine/tenofovir disoproxil fumarate (trade name Truvada®) that providers will write prescriptions for is the only medication currently approved for women. It is very well tolerated and taken once daily. Truvada prescriptions will be provided in accordance with standard clinical care. These decisions are not protocol/study-driven and not an intervention being studied by the trial.

Official Title
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IGHID 12227 - Pilot Mobile Medical Unit Study for I'm Fully Empowered4Her (IFE4Her) Intervention on HIV Pre-Exposure Prophylaxis (PrEP) Uptake by Women Living in Durham Housing Authority - Affiliated Communities (IFE4Her Pilot Study)

Conditions
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HIV Prevention, Pre-exposure Prophylaxis, PrEP, Prevention, Women's Health, Mobile Health

Intervention / Treatment
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* Other: I'm Fully Empowered for Her (IFE4Her)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 18 years of age or older Identify as female Currently reside in Durham Housing Authority (DHA) housing Exclusion Criteria: Currently on PrEP or Post-Exposure Prophylaxis (PEP) HIV-positive Being Male Gender Altered mental status precluding participant to provide informed consent Currently Pregnant or Trying to get Pregnant or Lactating.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mobile Medical Unit<br>Participants utilizing the mobile medical unit will be offered an appointment with a university system healthcare provider to receive blood pressure check, blood glucose check, HIV testing and/or Pre-exposure Prophylaxis (PrEP) consultation. | Other: I'm Fully Empowered for Her (IFE4Her)<br>* IFE4Her consists of 2 key components: 1) An awareness-raising messaging campaign with messages about PrEP that includes posters and Peer Networkers; and 2) access via a mobile medical unit outreach delivery model linking women in public housing to care from the PrEP providers of a university healthcare system and other complementary screening services (i.e., blood pressure, blood glucose monitoring, and HIV testing).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Intervention Acceptability - Mean Score of Satisfaction Questionnaire (range 1-5 with higher scores meaning greater satisfaction) | Perceived satisfaction with the intervention as assessed through survey items | Immediately post-mobile medical unit visit (assessed an average of 10 minutes post mobile medical unit visit) | 
| Intervention Acceptability - Number of Completed PrEP Consultations | Number of mobile clinic clients completing a PrEP consultation with a study provider as recorded by study staff in service records | Immediately post-mobile medical unit visit (assessed an average of 10 minutes post mobile medical unit visit) | 
| Intervention Acceptability Assessed Qualitatively | Perceived acceptability of the intervention as assessed in qualitative in-depth interviews with mobile clinic clients To gain deeper insights about the perceived acceptability of the intervention the investigators will ask participants in in-depth interviews about how they about different aspects of the intervention, including services provided and their delivery. Acceptability will be defined as a positive rating (and reason for that rating) of participant satisfaction with each aspect of the intervention. | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PrEP uptake - Number of PrEP Prescriptions Written in the Mobile Clinic | PrEP uptake, assessed as PrEP prescriptions written for women in the target population from the mobile PrEP unit evaluated through service records | Immediately post-mobile medical unit visit (assessed an average of 10 minutes post mobile medical unit visit) | 
| PrEP persistence -Proportion of Participants Receiving a PrEP Prescription Who Completed a Follow-Up visit and Received a Follow-Up PrEP Prescription | Persistence in PrEP care, assessed via chart review of follow-up appointments and prescriptions documented in Duke clinic records as the proportion of participants who received a PrEP prescription and completed a follow-up visit and received a follow-up PrEP prescription at 3 months (assessed retrospectively at 6 months). | 3 months | 
| PrEP Consultation Requests - Number of PrEP Appointments Requested | Number of mobile unit PrEP consultations (either scheduled or walk-in) requested as recorded in study tracking records and service logs. | Baseline | 
| PrEP Consultation Uptake - Number of PrEP Consultations Completed | Number of mobile unit PrEP consultations (either scheduled or walk-in) completed as recorded in mobile unit service logs | Immediately post-mobile medical unit visit (assessed an average of 10 minutes post mobile medical unit visit) |