Peer Outreach and Navigation Intervention to Increase PrEP Uptake Among Women at High Risk for HIV

HIV-1-infection Clinical Trial

Official title:

Assessing the Feasibility and Acceptability of a Peer Outreach and Navigation Intervention to Increase Pre-exposure Prophylaxis Uptake Among Women at High Risk for HIV

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT03226873
• Other study ID #: 2017-8139
• Secondary ID: 1U01PS005111-01
• Status: Completed
• Phase: N/A
• Start date: November 16, 2017
• Est. completion date: March 19, 2018

Study information

• Verified date: July 2018
• Source: Montefiore Medical Center
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This pilot study will assess the feasibility and acceptability of a peer outreach and navigation intervention designed to increase access and promote HIV pre-exposure prophylaxis (PrEP) uptake among women at high risk for HIV.

Description:

Women who engage in exchange sex (i.e., sex in exchange for money, drugs, or other services) remain are at substantial risk for HIV infection. (1-6) Due to a confluence of social and structural factors, exchange sex is relatively prevalent among women from socially and economically marginalized groups, such as women who are transgender, unstably housed/homeless and/or those who use and/or inject drugs. (1-3, 19-23) The overarching goal of this research is to decrease new HIV infections among women who engage in exchange sex. Daily oral HIV pre-exposure prophylaxis (PrEP) is an innovative method of HIV prevention that women, themselves, can control; as such, PrEP has the potential to reduce the risk of HIV acquisition among women who engage in exchange sex. Therefore, the investigators developed a theory-guided behavioral intervention (PrEP-UP) which utilizes street-based peer outreach and navigation to increase access to PrEP and promote PrEP uptake among women involved in exchange sex. Specifically, PrEP-UP involves a Peer delivering PrEP education and counseling during street-based outreach followed by offer of a PrEP care appointment along with peer navigation (e.g., appointment accompaniment and reminders, etc.) for the first several PrEP care visits. The objective of this study is to assess the feasibility and acceptability of PrEP-UP. To implement PrEP-UP, the investigators will collaborate with an established community-based organization (CBO) in East Harlem, NY, which uses street-based peer outreach and navigation to connect individuals to needed health and social services. Medical and pharmacy records will be reviewed to assess PrEP initiation. The investigators will conduct self-report surveys at baseline and at a week 4-12 follow-up visit that will collect data about sexual and drug use risk behaviors, perceived HIV risk, and PrEP-related knowledge, attitudes, and self-efficacy to assess for temporal changes in these variables. Additionally, individual interviews will be conducted post-intervention with a subset of the women as well as the CBO staff and leadership to access acceptability of the intervention.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 66
• Est. completion date: March 19, 2018
• Est. primary completion date: March 19, 2018
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. =18 years old

2. fluent in English

3. self-identifies as female or male-to-female transgender (or on the spectrum)

Exclusion Criteria

1) Incapable of providing informed consent (i.e., acutely intoxication, active psychosis, etc.)

Related Conditions & MeSH terms

• HIV-1-infection
• Pre-exposure Prophylaxis

Intervention

Behavioral:
• Peer Navigation
Peer education, counseling, and facilitation of PrEP care

Locations

Country	Name	City	State
United States	New York Harm Reduction Educators	New York	New York

Sponsors (2)

Lead Sponsor	Collaborator
Montefiore Medical Center	Centers for Disease Control and Prevention

Country where clinical trial is conducted

United States, 

References & Publications (23)

Bobashev GV, Zule WA, Osilla KC, Kline TL, Wechsberg WM. Transactional sex among men and women in the south at high risk for HIV and other STIs. J Urban Health. 2009 Jul;86 Suppl 1:32-47. doi: 10.1007/s11524-009-9368-1. Epub 2009 Jun 10. — View Citation

Denning P. HK, Paz-Bailey G.; for the NHBS Study Group. High Levels of HIV Infection Risk among Male Sex Partners of Low-Income Black Women in the United States. International AIDS Society on HIV Pathogenesis. Vancouver, Canada2015.

Dunkle KL, Wingood GM, Camp CM, DiClemente RJ. Economically motivated relationships and transactional sex among unmarried African American and white women: results from a U.S. national telephone survey. Public Health Rep. 2010 Jul-Aug;125 Suppl 4:90-100. — View Citation

Fletcher JB, Kisler KA, Reback CJ. Housing status and HIV risk behaviors among transgender women in Los Angeles. Arch Sex Behav. 2014 Nov;43(8):1651-61. doi: 10.1007/s10508-014-0368-1. Epub 2014 Sep 5. — View Citation

Golub SA, Kowalczyk W, Weinberger CL, Parsons JT. Preexposure prophylaxis and predicted condom use among high-risk men who have sex with men. J Acquir Immune Defic Syndr. 2010 Aug;54(5):548-55. doi: 10.1097/QAI.0b013e3181e19a54. — View Citation

Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N; HIV/AIDS Prevention Research Synthesis Team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008 Jan;12(1):1-17. Epub 2007 Aug 13. Review. — View Citation

Holt M, Murphy D, Callander D, Ellard J, Rosengarten M, Kippax S, de Wit J. HIV-negative and HIV-positive gay men's attitudes to medicines, HIV treatments and antiretroviral-based prevention. AIDS Behav. 2013 Jul;17(6):2156-61. doi: 10.1007/s10461-012-0313-z. — View Citation

Jenness SM, Kobrak P, Wendel T, Neaigus A, Murrill CS, Hagan H. Patterns of exchange sex and HIV infection in high-risk heterosexual men and women. J Urban Health. 2011 Apr;88(2):329-41. doi: 10.1007/s11524-010-9534-5. — View Citation

Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, Chesney MA. The role of self-efficacy in HIV treatment adherence: validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med. 2007 Oct;30(5):359-70. Epub 2007 Jun 23. — View Citation

Kalichman SC, Benotsch E, Suarez T, Catz S, Miller J, Rompa D. Health literacy and health-related knowledge among persons living with HIV/AIDS. Am J Prev Med. 2000 May;18(4):325-31. — View Citation

Kalichman SC, Rompa D. Functional health literacy is associated with health status and health-related knowledge in people living with HIV-AIDS. J Acquir Immune Defic Syndr. 2000 Dec 1;25(4):337-44. — View Citation

Kidder DP, Wolitski RJ, Pals SL, Campsmith ML. Housing status and HIV risk behaviors among homeless and housed persons with HIV. J Acquir Immune Defic Syndr. 2008 Dec 1;49(4):451-5. — View Citation

Marcus JL, Glidden DV, Mayer KH, Liu AY, Buchbinder SP, Amico KR, McMahan V, Kallas EG, Montoya-Herrera O, Pilotto J, Grant RM. No evidence of sexual risk compensation in the iPrEx trial of daily oral HIV preexposure prophylaxis. PLoS One. 2013 Dec 18;8(12):e81997. doi: 10.1371/journal.pone.0081997. eCollection 2013. — View Citation

Mimiaga MJ, Case P, Johnson CV, Safren SA, Mayer KH. Preexposure antiretroviral prophylaxis attitudes in high-risk Boston area men who report having sex with men: limited knowledge and experience but potential for increased utilization after education. J Acquir Immune Defic Syndr. 2009 Jan 1;50(1):77-83. doi: 10.1097/QAI.0b013e31818d5a27. — View Citation

Napper LE, Fisher DG, Reynolds GL. Development of the perceived risk of HIV scale. AIDS Behav. 2012 May;16(4):1075-83. doi: 10.1007/s10461-011-0003-2. — View Citation

Operario D, Soma T, Underhill K. Sex work and HIV status among transgender women: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2008 May 1;48(1):97-103. doi: 10.1097/QAI.0b013e31816e3971. Review. — View Citation

Raiford JL, Herbst JH, Carry M, Browne FA, Doherty I, Wechsberg WM. Low prospects and high risk: structural determinants of health associated with sexual risk among young African American women residing in resource-poor communities in the south. Am J Community Psychol. 2014 Dec;54(3-4):243-50. doi: 10.1007/s10464-014-9668-9. — View Citation

Rucinski KB, Mensah NP, Sepkowitz KA, Cutler BH, Sweeney MM, Myers JE. Knowledge and use of pre-exposure prophylaxis among an online sample of young men who have sex with men in New York City. AIDS Behav. 2013 Jul;17(6):2180-4. doi: 10.1007/s10461-013-0443-y. — View Citation

Sinoean C. LR, Nerlander L.M., Paz-Bailey G. Prevalence and Correlates of Exchange Sex among Low-Income Heterosexual Women in 21 Cities. Conference on Retroviruses and Opportunistic Infections. Seattle, WA2015.

Tobias CR, Cunningham W, Cabral HD, Cunningham CO, Eldred L, Naar-King S, Bradford J, Sohler NL, Wong MD, Drainoni ML. Living with HIV but without medical care: barriers to engagement. AIDS Patient Care STDS. 2007 Jun;21(6):426-34. — View Citation

Wechsberg W. Revised Risk Behavior Assessment (RBA), Part I and Part II. Research Triangle Park, NC: Research Triangle Institute; 1998.

Wechsberg WM, Lam WK, Zule W, Hall G, Middlesteadt R, Edwards J. Violence, homelessness, and HIV risk among crack-using African-American women. Subst Use Misuse. 2003 Feb-May;38(3-6):669-700. — View Citation

Whiteside YO, Harris T, Scanlon C, Clarkson S, Duffus W. Self-perceived risk of HIV infection and attitudes about preexposure prophylaxis among sexually transmitted disease clinic attendees in South Carolina. AIDS Patient Care STDS. 2011 Jun;25(6):365-70. doi: 10.1089/apc.2010.0224. Epub 2011 Apr 6. — View Citation

* Note: There are 23 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	PrEP prescription filled	Obtained from medical and/or pharmacy records	4-12 weeks
Secondary	HIV risk behaviors	Revised Risk Behavior Assessment (Wechsberg)	week 0, 4-12
Secondary	HIV risk perception	Perceived HIV Risk Scale (Napper)	week 0, 4-12
Secondary	Interest in PrEP	PrEP Acceptability Scale (Marcus)	week 0
Secondary	PrEP appointment acceptance	PrEP appointment acceptance (yes/ no)	week 0
Secondary	PrEP appointment scheduled	Scheduled PrEP appointment (yes/ no)	week 0-12
Secondary	PrEP appointment attendance	PrEP appointment attendance (yes/ no)	week 0-12
Secondary	PrEP-related knowledge	PrEP Knowledge Scale (Rucinski) (Kalichman) (Kalichman) (Whiteside)	week 0, 4-12
Secondary	PrEP-related attitudes	Attitudes Towards PrEP Measurements (Golub) (Holt) (Mimiaga) (Tobias)	week 0, 4-12
Secondary	PrEP-related self-efficacy	PrEP Self-Efficacy Scale (adapted from HIV-ASES) (Johnson)	week 0, 4-12