Department of Medicine (Infectious Diseases), Yale School of Medicine, New Haven, CT, United States of America.
Chronic Diseases Epidemiology, Yale School of Public Health, New Haven, CT, United States of America.
PLoS One. 2024 Sep 17;19(9):e0310837. doi: 10.1371/journal.pone.0310837. eCollection 2024.
Women exposed to intimate partner violence (IPV) experience multiple social and structural barriers to accessing HIV pre-exposure prophylaxis (PrEP), despite being at increased risk for HIV. In addition, few existing HIV prevention interventions address IPV. A recently developed PrEP decision aid for women has the potential to reach IPV survivors at risk for HIV if it could be integrated into existing domestic violence agencies that prioritize trust and rapport with female IPV survivors. Leveraging non-traditional service delivery mechanisms in the community could expand reach to women who are IPV survivors for PrEP.
We conducted qualitative interviews and online qualitative surveys with 33 IPV survivors and 9 domestic violence agency staff at two agencies in Connecticut. We applied the Consolidated Framework for Implementation Research (CFIR) to understand barriers and facilitators to delivering a novel PrEP decision aid to IPV survivors in the context of domestic violence service agencies.
Most IPV survivors and agency staff thought the PrEP decision aid intervention could be compatible with agencies' existing practices, especially if adapted to be trauma-responsive and delivered by trusted counselors and staff members. PrEP conversations could be packaged into already well-developed safety planning and wellness practices. Agency staff noted some concerns about prioritizing urgent safety needs over longer-term preventive health needs during crisis periods and expressed interest in receiving further training on PrEP to provide resources for their clients.
IPV survivors and agency staff identified key intervention characteristics of a PrEP decision aid and inner setting factors of the service agencies that are compatible. Any HIV prevention intervention in this setting would need to be adapted to be trauma-responsive and staff would need to be equipped with proper training to be successful.
尽管女性遭受亲密伴侣暴力（IPV）的风险增加，但她们在获得 HIV 暴露前预防（PrEP）方面面临着多种社会和结构性障碍。此外，现有的艾滋病毒预防干预措施很少涉及 IPV。最近开发的针对女性的 PrEP 决策辅助工具，如果能够整合到优先与女性 IPV 幸存者建立信任和融洽关系的现有家庭暴力机构中，有可能接触到有 HIV 风险的 IPV 幸存者。利用社区中非传统的服务提供机制，可以扩大接触到 PrEP 的 IPV 幸存者的范围。
我们对康涅狄格州两家机构的 33 名 IPV 幸存者和 9 名家庭暴力机构工作人员进行了定性访谈和在线定性调查。我们应用实施研究综合框架（CFIR）来了解在家庭暴力服务机构背景下向 IPV 幸存者提供新的 PrEP 决策辅助工具的障碍和促进因素。
大多数 IPV 幸存者和机构工作人员认为 PrEP 决策辅助干预措施可能与机构现有的做法兼容，特别是如果将其改编为对创伤有反应并由受信任的顾问和工作人员提供的方式。PrEP 对话可以纳入已经成熟的安全规划和健康实践。机构工作人员指出，在危机期间，他们优先考虑紧急安全需求而不是长期预防性健康需求存在一些问题，并表示有兴趣进一步接受 PrEP 培训，为客户提供资源。
IPV 幸存者和机构工作人员确定了 PrEP 决策辅助工具的关键干预特征和服务机构的内部环境因素，这些因素是兼容的。在这种情况下，任何艾滋病毒预防干预措施都需要适应对创伤有反应的方式，并且工作人员需要接受适当的培训才能取得成功。
