Optimizing PrEP Utilization among Alcohol and Other Drug (AOD) Using Women of Color

Project Summary: This administrative supplement (PA-18-591) in response to NOT-AA-20-011, leverages an existing NIAAA U34study for time-sensitive research on the impact of social environmental stressors related to COVID-19 on patientand provider experience in the HIV continuum of care for the most HIV-affected ethnic minority femalepopulations in S. Florida, now in one of the epicenters of the new pandemic. The public health emergency posedby COVID-19 has caused unprecedented disruption in daily living, social structures, and employment asmitigation mandates of social distancing have been enforced to slow the spread of illness. Emerging evidencesuggests that the most severe consequences from the novel coronavirus and the mitigation efforts will fall uponU.S. ethnic minority populations historically burdened by health disparities. The parent study, "Optimizing PrEPUtilization among Alcohol and Other Drug (AOD) Using Women of Color" (U34AA026219), is the first such projectdevoted to improving implementation and uptake of PrEP among African American, LatinX and Haitian womenin the HIV hotspots of S. Florida and has produced a replicable model driven by community-based participatoryresearch (CBPR). Before COVID-19, these study populations had limited economic resources, prevalent healthdisparities and reported high levels of intimate partner violence. The possible deleterious effects of the pandemichave not yet been investigated or reported for women of color in the South or for the HIV health care providersthat serve them. The supplement will utilize longitudinal, mixed methods data collection within the parent study'ssocial ecological framework to fill critical knowledge gaps about the pandemic's impact on engagement in careand adherence to PrEP and supportive services for alcohol and drug use, mental health, and other ancillary carein the three key ethnic minority populations of women. Our specific aims include: 1) remotely assess experiencesin AOD use, engagement in care, PrEP medication adherence, and HIV risk factors among a sample of womenof color at risk for HIV who are currently enrolled participants in the parent study, comparing measures takenpre-COVID-19, (T1), to post-COVID assessments, (T2 and T3), taken 3 months apart; 2) measure via internetsurveys changes in health services delivery and social distancing due to the pandemic on access to andperceived quality of care, patient trust, and provider stress among a group of health care workers whoparticipated in the community mobilization phase of the parent study; and 3) remotely conduct semi-structuredinterviews with a subset of women from Aim 1 and health providers from Aim 2 to explore COVID-relatedexperiences, needs, areas for improvement in care, and strategies to engage and retain AOD-using women inthe HIV continuum of care. The methods and implementation of the proposed aims will be fulfilled within theparent study's CBPR framework and will inform efforts to offset the adverse stressors of the pandemic andpreserve gains that have been made in HIV prevention in these populations.