Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States.
Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States.
AIDS Behav. 2022 Dec;26(12):3807-3817. doi: 10.1007/s10461-022-03709-2. Epub 2022 Jun 7.
Women involved in criminal justice systems (WICJ) are a key population at risk for HIV, and pre-exposure prophylaxis (PrEP) is critical for HIV prevention. This project was designed to evaluate the feasibility and acceptability of delivering PrEP via eHealth to WICJ and members of their risk network (RN). We recruited HIV-negative cisgender WICJ index participants (n = 38) and risk network (RN) members (n = 67) using modified respondent-driven sampling. TDF/FTC was initiated for PrEP in participants meeting clinical criteria and dispensed through eHealth using a community-based, low barrier-to-care outreach model. Key steps in the PrEP care continuum were measured over 12 months. Enrolled participants (n = 105) had high current and lifetime justice-involvement and were predominantly cisgender women and non-Hispanic white with a mean age of 40.9y (SD 9.6). Despite most having primary care providers and medical insurance, PrEP awareness was low, and participants experienced high levels of medical, psychiatric, substance use, social, and economic need. Fifty-two participants (50%) were PrEP-eligible, of whom 24 (46%) initiated PrEP. TDF/FTC was safe and well-tolerated throughout follow-up and 13 individuals chose to remain on PrEP following study conclusion. In this novel PrEP demonstration project for WICJ and RN members, despite high medical, psychiatric, and social comorbidity, PrEP was positively received and effectively delivered using a community outreach model via eHealth.Registered on clinicaltrials.gov under trial registration number NCT03293290.
参与刑事司法系统的女性（WICJ）是感染 HIV 的高危人群，暴露前预防（PrEP）对预防 HIV 至关重要。本项目旨在评估通过电子健康向 WICJ 和其风险网络（RN）成员提供 PrEP 的可行性和可接受性。我们使用改良的应答驱动抽样法招募了 38 名 HIV 阴性顺性别 WICJ 索引参与者和 67 名风险网络（RN）成员。在符合临床标准的参与者中启动 TDF/FTC 进行 PrEP，并通过电子健康使用以社区为基础、低障碍护理外展模式进行配药。在 12 个月内测量了 PrEP 护理连续体的关键步骤。入组的参与者（n=105）当前和终身的司法参与度较高，主要是顺性别女性和非西班牙裔白人，平均年龄为 40.9 岁（SD 9.6）。尽管大多数参与者有初级保健提供者和医疗保险，但 PrEP 的意识很低，参与者经历了高水平的医疗、精神、药物使用、社会和经济需求。52 名参与者（50%）有资格接受 PrEP，其中 24 名（46%）开始接受 PrEP。在整个随访期间，TDF/FTC 是安全且耐受良好的，13 人在研究结束后选择继续接受 PrEP。在这个针对 WICJ 和 RN 成员的新型 PrEP 示范项目中，尽管存在高度的医疗、精神和社会合并症，但 PrEP 受到了积极的欢迎，并通过电子健康的社区外展模式有效提供。在 clinicaltrials.gov 上注册，注册号为 NCT03293290。
