PROJECT SUMMARY/ABSTRACT: The goal of this research is to prevent HIV among women who inject drugs (WWID) through organization-level change in the way pre-exposure prophylaxis (PrEP) is delivered to this population. Dr. Starbird is proposing a research and career development plan which will prepare her to independently evaluate system-level interventions to improve care delivery to WWID with high capacity for implementation. WWID are among the most vulnerable to acquiring HIV due to the dual effects of both unsafe injecting and sexual practices. PrEP is effective and recommended to prevent HIV infection among high-risk groups, including WWID. However, PrEP uptake among WWID is lagging – 92% of people who receive PrEP in New York State are men. Interventions at the organizational level present an opportunity to improve PrEP delivery and decrease gender disparities among people who inject drugs, particularly in primary and reproductive healthcare settings which can engage WWID in ongoing PrEP use when they present for comorbidity management, psychosocial services, or pregnancy support. Including PrEP for WWID in often under-resourced and stretched primary and reproductive healthcare settings poses organizational challenges that may be eliminated with Practice Facilitation. Practice Facilitation is an evidence-based strategy to support clinics' abilities to implement an intervention such as PrEP through technical assistance, logistical support, and external partnership building. This study will leverage NIDA's investment in the HEALing Communities Study in New York State (UM1 DA049415, PI: El-Bassel, primary mentor) to achieve the following specific aims: 1) explore the opinions of WWID about how PrEP is delivered to them, 2) examine the provider- and organization- level barriers and facilitators to delivering PrEP to WWID, and 3) adapt and pilot test the feasibility and acceptability of Practice Facilitation to improve PrEP delivery to WWID in primary and reproductive healthcare settings. We hypothesize that PrEP Practice Facilitation will be feasible and acceptable to primary and reproductive healthcare organizations and demonstrate potential to increase the proportion of WWID who receive a prescription for PrEP. Dr. Starbird has contributed to understanding the efficacy, effectiveness, and economic implications of interventions for individuals with substance use disorder, HIV, and hepatitis C. This Mentored Research Scientist Development Award builds on this experience and extends it with training in four key skills: 1) advanced qualitative analysis, 2) organizational behavior change, 3) implementation science, and 4) ethical conduct of research with vulnerable women. The proposed K01 will provide training, mentorship, and research experience that will serve as the foundation for Dr. Starbird's career as an independent investigator dedicated to improving healthcare delivery for marginalized populations. This project is well-aligned with the strategic objectives of NIDA and also directly in line with the Office of AIDS Research cross-cutting areas of Health Disparities and Implementation Science Research to reduce the incidence of HIV.

PROJECT NARRATIVE Women who inject drugs are among the most vulnerable to acquiring HIV, but very few women who inject drugs are prescribed pre-exposure prophylaxis (PrEP) for HIV prevention largely due to barriers within our healthcare system. This research will consider the perspectives of women who inject drugs, healthcare providers, and clinic leadership to improve the way primary care and reproductive health clinics deliver PrEP to women who inject drugs, thereby reducing new HIV infections in this population. The research and training in this application will prepare the candidate for an independent scientific career conducting intervention research among vulnerable populations with high capacity for real-world implementation and dissemination.