TY - JOUR
T1 - A Novel Capacity-Strengthening Intervention for Frontline Harm Reduction Workers to Support Pre-exposure Prophylaxis Awareness-Building and Promotion Among People Who Use Drugs
T2 - Formative Research and Intervention Development
AU - Glick, Jennifer L.
AU - Zhang, Leanne
AU - Rosen, Joseph G.
AU - Yaroshevich, Karla
AU - Atiba, Bakari
AU - Pelaez, Danielle
AU - Park, Ju Nyeong
N1 - Funding Information:
JLG and Johns Hopkins University receive grant funding from ViiV Healthcare to conduct pre-exposure prophylaxis–related research. JNP served as a consultant for Harvard Medical School through a cooperative grant from the Food and Drug Administration (U01FD00745501). The authors have no additional conflicts of interest to declare.
Funding Information:
We wish to acknowledge Lyra Cooper, Praise Olatunde, C To, and Teagan Toomre for their work on the Optimizing Pre-exposure Prophylaxis (PrEP) Engagement Among Women Living in Baltimore City (OPAL) formative research team. We also thank all frontline harm reduction workers who participated in the PrEP promotion training and evaluation activities. This work was supported by the Johns Hopkins University Center for AIDS Research, a National Institutes of Health–funded program (1P30AI094189). JLG and JGR were supported, in part, by a grant from an internal Johns Hopkins University COVID-19 Bridge Grant. JGR was supported by a predoctoral training grant from the National Institute of Mental Health (F31MH126796). JNP was supported by a grant from the National Institute of General Medical Sciences (P20GM125507).
Publisher Copyright:
© Jennifer L Glick, Leanne Zhang, Joseph G Rosen, Karla Yaroshevich, Bakari Atiba, Danielle Pelaez, Ju Nyeong Park.
PY - 2023
Y1 - 2023
N2 - Background: HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet its usefulness is low among PWUD in Baltimore City and the United States. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited. Objective: We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRWs) to support PrEP awareness-building and promotion among PWUD. Methods: Our study was implemented in 2 phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as the existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a 1-time, 2-hour training with FHRWs aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (eg, facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, and referring clients to PrEP services). In a separate paper, we describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRWs participating in the training. Results: The pilot was developed from October to December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRWs into the intervention. A total of 39 FHRWs from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators. Conclusions: This intervention could prevent the HIV burden among PWUD by leveraging the relationships that FHRWs have with PWUD and by supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD worldwide.
AB - Background: HIV prevalence among people who use drugs (PWUD) in Baltimore, Maryland, is higher than among the general population. Pre-exposure prophylaxis (PrEP) is a widely available medication that prevents HIV transmission, yet its usefulness is low among PWUD in Baltimore City and the United States. Community-level interventions to promote PrEP uptake and adherence among PWUD are limited. Objective: We describe the development of a capacity-strengthening intervention designed for frontline harm reduction workers (FHRWs) to support PrEP awareness-building and promotion among PWUD. Methods: Our study was implemented in 2 phases in Baltimore City, Maryland. The formative phase focused on a qualitative exploration of the PrEP implementation environment, as well as facilitators and barriers to PrEP willingness and uptake, among cisgender women who use drugs. This work, as well as the existing literature, theory, and feedback from our community partners, informed the intervention development phase, which used an academic-community partnership model. The intervention involved a 1-time, 2-hour training with FHRWs aimed at increasing general PrEP knowledge and developing self-efficacy promoting PrEP in practice (eg, facilitating PrEP dialogues with clients, supporting client advancement along a model of PrEP readiness, and referring clients to PrEP services). In a separate paper, we describe the conduct and results of a mixed methods evaluation to assess changes in PrEP-related knowledge, attitudes, self-efficacy, and promotion practices among FHRWs participating in the training. Results: The pilot was developed from October to December 2021 and implemented from December 2021 through April 2022. We leveraged existing relationships with community-based harm reduction organizations to recruit FHRWs into the intervention. A total of 39 FHRWs from 4 community-based organizations participated in the training across 4 sessions (1 in-person, 2 online synchronous, and 1 online asynchronous). FHRW training attendees represented a diverse range of work cadres, including peer workers, case managers, and organizational administrators. Conclusions: This intervention could prevent the HIV burden among PWUD by leveraging the relationships that FHRWs have with PWUD and by supporting advancement along the PrEP continuum. Given suboptimal PrEP uptake among PWUD and the limited number of interventions designed to address this gap, our intervention offers an innovative approach to a burgeoning public health problem. If effective, our intervention has the potential to be further developed and scaled up to increase PrEP awareness and uptake among PWUD worldwide.
KW - formative research
KW - harm reduction
KW - intervention development
KW - people who use drugs (PWUD)
KW - pre-exposure prophylaxis (PrEP)
UR - http://www.scopus.com/inward/record.url?scp=85154609603&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85154609603&partnerID=8YFLogxK
U2 - 10.2196/42418
DO - 10.2196/42418
M3 - Article
C2 - 37052977
AN - SCOPUS:85154609603
SN - 2561-326X
VL - 7
JO - JMIR Formative Research
JF - JMIR Formative Research
M1 - e42418
ER -