HIV Clinical Trial
Official title:
Connecting Resources for Urban Sexual Health: CRUSH-PrEP for Women
UCSF is conducting an evaluation of a demonstration project. The aims of the CRUSH-PrEP for Women project are to integrate the delivery of a comprehensive PrEP package for HIV-negative at-risk women into primary care settings. The delivery of the PrEP package will leverage the well regarded reputation of the LifeLong primary care clinicians to provide a highly effective combination HIV prevention strategy including; PrEP, post-exposure prophylaxis (nPEP), repeat HIV and STI testing, treatment of sexually transmitted infections. Counselling for for sexual health promotion and services specifically designed for vulnerable women such as staying free of violence and domestic abuse will be offered as an integrated part of this package. UCSF will conduct evaluation activities only. The investigators expect that UCSF will enroll 50 participants in the evaluation assessments across the 15 months of data collection. Evaluation cohort participants will provide quantitative data to evaluate the linkage and engagement in care among clinic attendees as well as the uptake and use of Pre-Exposure Prophylaxis.
The overall goal of the CRUSH PrEP for Women Project is to enhance and extend a response to
the local HIV/AIDS epidemic in Alameda County with a set of innovative, evidence-based
interventions across the continuum of HIV prevention and care, which target the individuals
and communities that are the most vulnerable to HIV infection. The investigators hypothesize
that women in Oakland will be interested in accessing PrEP through a community based clinic.
Specifically, the CRUSH PrEP for Women Project is a 16month demonstration project designed to
evaluate and assess the adherence of PrEP within a community based clinic. The specific aims
of the project are as follows:
Aim 1. Assess uptake and adherence to PrEP among women in the study: Uptake will be measured
as the proportion of female patients at the LifeLong clinic who are approached that start
PrEP after being offered PrEP, the numbers and rate of PrEP discontinuation, the reasons
given for PrEP discontinuation (side effects, no longer at risk, fear of stigma, inability to
adhere), and drug concentrations. Drug concentrations are monitored using dried blood spots,
which have a large dynamic range capable of detecting use of a few pills every month up
through daily use. The main measure of PrEP utilization is the proportion of time that PrEP
is used effectively among those attempting to use PrEP. Because the effective dose of PrEP is
less well characterized for women, only blood concentration levels consistent with daily use
will be considered effective use for this analysis. After the supply of study provided
medication is ended at 12 months, participants will be followed for an additional 3 months to
determine the proportion who continued on PrEP. The investigators will describe patterns of
use and the barriers and facilitators to continued use beyond one year. The investigators
will look at demographic, and psychosocial and risk factors that may be associated with less
than daily adherence to medication, and describe reasons for early discontinuation of PrEP
among any women who choose to stop taking medication prior to the end of the first 12 months.
Factors associated with discontinuation at the end of the 12-month study provided supply of
medication will also be described. Although these analyses will be exploratory, the
investigators hypothesize that changes in relationships and pregnancy intentions will be
related to changes in PrEP use.
Aim 2. Assess the characteristics of women who enroll in the PrEP study: For Aim 2, the
investigators are interested in characterizing the women who decide to take PrEP through this
project. Demographic and psychosocial variables will be used to describe the population who
enroll. Sexual and behavioral risk profiles of those who decide to initiate PrEP will also be
described as part of this study. Demographics of women who uptake PrEP through our community
partners will also be compared to the demographics of Alameda County women who have incident
HIV infection. In addition to demographics and risk behavior, the investigators will also
describe the contraceptive use and intentions of women on PrEP towards future pregnancies as
these may be important factors driving interest in PrEP among women.
Aim 3: Assess the referral sources of women who enroll in the PrEP study: Process data will
capture the outreach efforts made to recruit participants for this study. At the time of
baseline visit, the source of referral for each woman screened will be captured, as well as
the primary reason for joining the study. Enrollment progress will be carefully tracked
against outreach activities to monitor the relationship between outreach efforts and demand
generation. This will help to inform future implementation of PrEP among women.
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