Improving HIV Prevention Through a Psychological Flexibility-Based Approach

There continues to be a high incidence of HIV, particularly in the South. Thus, interventions to enhance engagement in prevention services are urgently needed. Engagement in pre-exposure prophylaxis (PrEP) care among people at risk of HIV living in Mississippi is less then optimal. The modified social ecological model defines the multi-level domains of HIV infection risk. Barriers to PrEP use occur at each level: 1) individual, 2) social network, 3) community, 4) policy, and 5) stage of the HIV epidemic. Examples include individual (e.g. perception of HIV risk), social (e.g. partner risk), community (e.g. lack of medical services), and public policy (e.g. cost of care and transportation). The boundary between each level is permeable, thus each is considered in the proposed study. Utilizing components of Acceptance and Commitment Therapy (ACT), we will design an intervention to improve PrEP uptake, persistence, and adherence. We will use a generalized framework for the adaptation of evidence based interventions to inform the development of a brief intervention for PrEP, named ACT PrEP. ACT addresses barriers by promoting: 1) present moment awareness, 2) acceptance of internal and external experiences, and 3) engagement in behaviors that are consistent with values. To maximize utility, ACT PrEP will be delivered by a PrEP navigator.

Candidate: Dr. Arnold is a medical clinical psychologist/scientist with a research background in HIV. Her career has focused on HIV intervention and prevention among adults. Building on prior research, she is applying for a five-year Career Development Award to become an expert in clinically informed behavior change interventions and an investigator capable of future funding.

Research: The proposed aims are 1) Gather data from patients (n = 20) and clinic staff (n = 10) through in-depth interviews to assess quantitative measures, intervention design, and barriers; 2) Develop ACT PrEP utilizing Aim 1 data, working iteratively with experts, and an intervention “run through”; and 3) Evaluate ACT PrEP feasibility and acceptability through a randomized control trial (n=66) and compare ACT PrEP vs. enhanced standard of care condition on behavior outcomes (uptake, adherence, and PrEP persistence).

Trainings: Dr. Arnold will receive specific training in designing and testing theory-based interventions, implementation science, and quantitative analyses through coursework, seminars, workshops, and mentored research. These training and research experiences will establish the candidate’s career as an expert in intervention and implementation science. The candidate is supported by Rhode Island Hospital, Department of Psychiatry.

Grant Number: 5K23MH124539-05
NIH Institute/Center: NIH
Principal Investigator: Trisha Arnold